A biopsy report describes Tzanck cells. Following primary infection, the causative virus becomes latent in which ganglia?

Correct answer: D. Trigeminal ganglion

• A. ❌ The superior cervical ganglion is sympathetic and is not a viral reservoir.
• B. ❌ The submandibular ganglion is parasympathetic, relaying secretomotor fibers to the submandibular and sublingual glands.
• C. ❌ The geniculate ganglion is the facial nerve's sensory ganglion. VZV reactivation there produces Ramsay Hunt syndrome, but it is not the principal orofacial latency site.
• D. ✅ CORRECT — Tzanck cells (acantholytic, virally altered epithelial cells with ballooning degeneration and multinucleation) point to herpes family infection. HSV-1 and varicella-zoster establish latency in the sensory ganglia — for the orofacial region, the TRIGEMINAL (Gasserian) ganglion.

Note: Tzanck cells appear in HSV, VZV and pemphigus vulgaris — the smear is suggestive, not definitive. Biopsy with immunofluorescence gives the diagnosis.