Pathology · patient case question
Shingles results from reactivation of which virus?
Patient case: Shingles, neuralgia and a toothache that is not one
demo: 62-year-old male
chief: Severe pain in the upper right teeth for three days, with no obvious dental cause.
history: Recent bereavement and poor sleep. Chickenpox as a child.
meds: None.
findings: All maxillary right teeth respond normally to pulp testing and are non-tender to percussion. Two days later a unilateral vesicular rash appears on the right cheek and hard palate, stopping abruptly at the midline. Separately, another patient describes brief, electric-shock facial pain triggered by shaving.
Show answer and explanation
Correct answer: D. Varicella-zoster virus
- A. EBV causes infectious mononucleosis and oral hairy leukoplakia.
- B. Coxsackie A causes herpangina and hand, foot and mouth disease, which are bilateral and affect the posterior oropharynx.
- C. HSV-1 causes primary herpetic gingivostomatitis and recurrent herpes labialis, which are not dermatomal and do not respect the midline in this way.
- D. Correct. Primary varicella-zoster infection causes chickenpox, after which the virus remains latent in the dorsal root and trigeminal sensory ganglia. Reactivation, prompted by ageing, stress or immunosuppression, produces herpes zoster: a painful unilateral dermatomal vesicular eruption that stops at the midline.