COVID‐19 and herpes zoster co‐infection presenting with trigeminal neuropathy

de Freitas Ferreira, Ana Carolina Andorinho; Romão, Tayla Taynan; SIlva Macedo, Yuri; Pupe, Camila; Nascimento, Osvaldo JM

BACKGROUND: Varicella‐zoster virus (VZV) is a human neurotropic virus that remains in a latent state within ganglionic neurons throughout the entire neuroaxis after the primary infection. Whenever herpes zoster leads to trigeminal involvement, the ophthalmic division is the most implicated. COVID‐19 emerged as a viral cause of severe acute respiratory syndrome that spread all over the world in the last months. Co‐infection with COVID and other viruses has been registered, but sparsely and embracing the respiratory ones. METHODS: report a case of a co‐infection of COVID‐19 with VZV, and review the literature. RESULTS: 39‐year‐old immunocompetent man with oligosymptomatic infection by COVID‐19 evolved to left facial herpes zoster affecting the three divisions of trigeminal nerve. The co‐infection was remotely registered with other respiratory virus, being influenza the most mentioned. However, the present case is associated to the emergence of a latent virus infection, which might be related to the viral inflammatory response, especially ascending from the nasal cavity, where trigeminal branches are also placed. CONCLUSIONS: The emergence of the latent infection by VZV under a rare presentation might illustrate the impact at least locally of COVID‐19, once retrograde reactivation of VZV was possibly induced in a young immunocompetent patient.