SHM Converge Scientific Abstract ePoster Gallery-More Than Meets the Eye: Extreme Cutaneous and Ocular Shingles

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This case report describes a severe and unusual presentation of trigeminal trophic syndrome (TTS) complicating herpes zoster ophthalmicus in a 58-year-old Spanish-speaking man. The patient developed a sharply demarcated, desquamative and ulcerative rash over the right trigeminal dermatome, extending from the scalp to the upper lip and involving the eyelid and nasal ala. He also had significant ocular disease, including hypopyon, necrotizing stromal keratitis, and a corneal ulcer, along with systemic signs of sepsis and a superimposed Staphylococcus aureus infection.<br /><br />Initially, the rash was misdiagnosed as poison ivy, then treated as shingles with little improvement. During hospitalization, he received IV acyclovir, antibiotics, topical antimicrobials, pain control, and a corneal bandage, but he repeatedly rubbed and scratched the affected areas despite repeated education through a translator. His ongoing self-manipulation worsened tissue destruction, prevented healing, and contributed to progressive eye damage. On readmission, his corneal ulcer worsened and ultimately required an amniotic membrane graft and temporary, then permanent, tarsorrhaphy.<br /><br />The authors emphasize that TTS can be difficult to recognize, especially when there is no clear prior history of trigeminal nerve injury or herpes zoster. In this patient, delayed diagnosis and inadequate control of pain and behavior likely allowed continued self-injury and severe tissue loss. The case highlights the importance of early recognition of TTS, aggressive pain management, and behavioral or physical strategies to prevent manipulation of the face. The authors suggest that prosthetic devices and medications such as carbamazepine, chlorpromazine, or amitriptyline may have helped reduce symptoms and self-trauma.

Asset Subtitle

Bryn Cross

Meta Tag

Author List Alan A. Kubey, Bryn Cross, Yazmine Castillo

Category Clinical Vignettes

Concept Herpes Zoster Ophthalmicus

Concept Trigeminal Trophic Syndrome

Concept Ocular Complication

Concept Pain

Concept Self-Manipulation

Distinguished Non-Finalist

Presenter Organization Sidney Kimmel Medical College-Thomas Jefferson University

Presenting Author Bryn Cross

Track Adult

Keywords

trigeminal trophic syndrome

herpes zoster ophthalmicus

corneal ulcer

necrotizing stromal keratitis

hypopyon

Staphylococcus aureus infection

self-manipulation

tissue destruction

tarsorrhaphy

amniotic membrane graft

Herpes Zoster Ophthalmicus

Trigeminal Trophic Syndrome

Ocular Complication

Pain

Self-Manipulation