A 25-year-old man presents with vesicular eruption on the tip of the nose (Hutchinson's sign) and painful eye. Slit-lamp examination shows pseudodendrites on the cornea. Which herpes virus is responsible, and what is the significance of Hutchinson's sign?
- A HSV-1 reactivation; Hutchinson's sign indicates corneal involvement
- B CMV reactivation in an immunocompetent host; sign predicts retinal necrosis
- C Varicella-Zoster Virus reactivation in ophthalmic division of trigeminal nerve (V1); indicates nasociliary branch involvement predicting ocular complications ✓
- D EBV causing herpes zoster ophthalmicus; sign correlates with uveitis risk only
Correct answer: C. Varicella-Zoster Virus reactivation in ophthalmic division of trigeminal nerve (V1); indicates nasociliary branch involvement predicting ocular complications
Explanation
Herpes zoster ophthalmicus (HZO) is caused by reactivation of VZV in the ophthalmic division (V1) of the trigeminal nerve. Hutchinson's sign (vesicles on the tip and side of the nose) indicates involvement of the nasociliary branch of V1, which also supplies the eye — the presence of this sign has ~76% positive predictive value for serious ocular involvement including keratitis, uveitis and glaucoma. Immediate ophthalmology referral and antiviral therapy (acyclovir/valacyclovir) are mandatory. HSV-1 causes true dendrites (not pseudodendrites) on cornea.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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