Work

Disseminated Herpes Zoster Leading to Orbital Apex Syndrome: A Case of MRI-Negative Cranial Neuropathy

Year: 2026

Type: article

Abstract: Varicella-zoster virus (VZV) establishes latency in neuronal ganglia following primary infection and can later reactivate as herpes zoster. Disseminated zoster may occur in some cases and is characterized by vesicular lesions appearing beyond the initially affected dermatome. When the ophthalmic branch of the trigeminal nerve is involved, herpes zoster ophthalmicus can develop and may lead to a range of ocular complications. Neurological sequelae are less common, and orbital apex syndrome represents a rare but potentially severe manifestation. This syndrome involves dysfunction of the optic nerve and adjacent cranial nerves within the optic canal and superior orbital fissure, with possible vision loss and ophthalmoplegia. We describe a case of disseminated VZV infection complicated by orbital apex syndrome with cranial nerve III palsy in an immunosuppressed patient, illustrating the diagnostic challenges encountered when clinical findings evolve before confirmatory imaging.

Source: Cureus

DOI: 10.7759/cureus.101598

Authors: Brock M Davis, Matthew Waite, Ethan Taylor, Jarod Meecham, Harrison Gregory

Institutions: Community Health Systems - Northeast Regional Medical Center, A.T. Still University

Language: English

Topic: Herpesvirus Infections and Treatments

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7124241290