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HZO Hutchinson Immunosuppressed — SCE Infectious Diseases MCQ

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EasyImmunocompromised HostHZO Hutchinson ImmunosuppressedSCE Infectious Diseases

A 45-year-old woman with SLE on Mycophenolate and Hydroxychloroquine develops herpes zoster affecting V1 (ophthalmic division) with ipsilateral Hutchinson sign (vesicles on the nose tip). What is the risk and management?

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Correct answer: A — Hutchinson sign predicts ~75% risk of ocular complications (keratitis, uveitis, glaucoma); urgent ophthalmology referral plus antiviral therapy (IV Aciclovir if immunocompromised) is required

Hutchinson sign indicates involvement of the nasociliary branch of V1, which also innervates the cornea. In immunocompromised patients (SLE on immunosuppression), IV Aciclovir is preferred over oral therapy for HZO. Urgent ophthalmology assessment for: dendritic keratitis, stromal keratitis, anterior uveitis, acute retinal necrosis, and raised IOP. Long-term follow-up for post-herpetic neuralgia and chronic ocular inflammation.

Reference: NICE CKS 2024 – Shingles; RCOphth 2023 – HZO