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Ipsilateral truncal sensory deficit in a patient with ophthalmic zoster sine herpete

Herpes zoster (HZ) and zoster sine herpete (ZSH), defined as pain in a dermatomal distribution without the rash of cutaneous zoster, result in an array of neurologic complications.1 We report a patient with ophthalmic ZSH that had the unusual complication of sensory disturbance over the ipsilateral upper trunk. Brain MRI showed an abnormal signal lesion in the medulla, possibly regional encephalitis due to direct invasion of varicella zoster virus (VZV).

A 46-year-old immunocompetent man developed acute painful neuralgia in the first division of his left trigeminal nerve without skin rash. In 7 days, numbness spread over the left half of his face, head, neck, and entire left arm. Three days later, he awoke to left facial palsy and tinnitus in his left ear, leading to hospitalization. On admission, he had generalized headache and low-grade fever with mild neck stiffness. He showed complete left facial palsy and sensorineural hearing loss in his left ear. His palate moved symmetrically, and the …