長達三個月帶狀皰疹前驅痛以非典型臉痛表現病例報告

Extremely prolonged prodromal pain due to herpes zoster mimicking atypical facial pain

帶狀皰疹（HZ）是由水痘－帶狀皰疹病毒（VZV）的再激活引起的，水痘－帶狀皰疹病毒在最初的水痘感染後仍然在顱神經和脊髓神經中休眠。囊泡形成前的皮膚疼痛的前驅期，被描述為灼燒，瘙癢或射擊感，具有臨床意義。其平均持續時間約為5天，疼痛的平均嚴重程度約為6（VAS等級0～10）。HZ的前驅症狀可能在老年人或免疫抑制患者中嚴重且持續時間延長。在這裡，我們提出一個88歲的男性在典型的帶狀皰疹囊泡出現前3個月有前驅面部疼痛。他最初是由牙醫，耳鼻喉科醫生，神經科醫生和疼痛醫生看到的。在此期間的身體檢查和診斷測試，包括腦部MRI和MRA，沒有確定疼痛的確切原因，首次診斷為伴有顳頜關節綜合徵和胸鎖乳突肌肌筋膜疼痛的緊張型頭痛。然後才出現右耳道中的皰疹被診斷患有帶狀皰疹，並且成功地用抗病毒藥物和類固醇治療。該病例表明，排除其他鑑別診斷後，如果其他治療方法在減少神經痛方面效果有限，即使沒有併發皮疹，也應考慮普瑞巴林（pregabalin）在老年人或免疫抑制患者中的應用。

Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus (VZV), which remains dormant in cranial and spinal root nerves after the initial chicken pox infection. The prodromal period of dermatomal pain before vesicle eruption, described as a burning, itching or shooting sensation, is clinically significant. Its mean duration is about 5 days and the mean severity of pain is about 6 on a VAS scale of 0 to 10. The prodrome of HZ may be severe and prolonged in aged or immunosuppressed patients. Herein, we present an 88 year old man had prodromal facial pain for 3 months before the appearance of typical herpes zoster vesicles. He was initially seen by a dentist, an ENT doctor, a neurologist, and a pain physician. Physical examination and diagnostic tests during this period, including brain MRI and MRA, did not identify a definitive cause of the pain, and he received an initial diagnosis of tension type headache with temporomandibular joint syndrome and sternocleidomastoid myofascial pain. Eruption of vesicles in the right ear duct then appeared, and he was diagnosed with herpes zoster oticus, and was successfully treated with acyclovir and prednisone. The case suggest that HZ should be considered in aged or immunosuppressed patients after exclusion the other differential diagnosis and pain treatment with pregabalin attempted if other treatments have limited efficacy in reducing neuralgia, even without a concurrent skin rash.