内科・老年内科

A previously healthy 70-year-old man who underwent dental treatment for left maxillary toothache 1 week previously presented to us with facial swelling. He had experienced facial tenderness along with a tingling sensation in his mouth for several days. Physical examination revealed puffy skin on the left side of his face, reaching his left lid margin, without apparent vesicular rash. There was no facial paralysis. We initially suspected a bacterial soft tissue infection induced by the preceding dental procedure. However, intraoral inspection uncovered white erosion produced at the left hard palate clearly separated at the midline (figure 1). Specific antibodies for human herpes virus were negative, while the serum level of varicella-zoster virus specific IgG level was highly elevated at 1240 (enzyme immunoassay; reference range, <2). Accordingly, we diagnosed the patient with reactivation of herpes zoster involving the maxillary nerve (V2) dermatome of the left trigeminal nerve. The symptoms subsided following intravenous administration of acyclovir for 1 week; however, postherpetic neuralgia remained, causing a left-sided burning sensation on his face and hard palate.