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Herpes Zoster Ophthalmicus Hutchinson — ESENeph MCQ

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ModerateRenal VasculitisHerpes Zoster Ophthalmicus HutchinsonESENeph

A 55-year-old man with ANCA vasculitis in remission on Azathioprine develops a herpes zoster reactivation affecting the ophthalmic division of the trigeminal nerve (V1). He has vesicles on the tip of the nose (Hutchinson sign). What is the clinical significance?

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Correct answer: B — Herpes zoster ophthalmicus with Hutchinson sign indicates involvement of the nasociliary branch and high risk of ocular complications (keratitis, uveitis, secondary glaucoma) – urgent ophthalmology review and IV Aciclovir are needed

Hutchinson sign (vesicles on the nose tip) indicates nasociliary nerve involvement, which also innervates the cornea. This carries a >70% risk of ocular complications including keratitis, uveitis, and secondary glaucoma, potentially causing permanent vision loss. In immunosuppressed patients (Azathioprine), herpes zoster ophthalmicus warrants urgent ophthalmology referral, IV Aciclovir (rather than oral – immunosuppression increases dissemination risk), and consideration of immunosuppression reduction. Renal dose adjustment of Aciclovir is essential.

Reference: NICE – Shingles; Royal College of Ophthalmologists – HZO