Oral Herpes Zoster — ORE Part 1 MCQ

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ModerateOral MedicineOral Herpes ZosterORE Part 1

A 48-year-old woman presents with painful vesicles affecting the hard palate and attached gingiva on the right side. The lesions are sharply unilateral and do not cross the midline. She had chickenpox during childhood. What is the most likely diagnosis?

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Correct answer: E — Maxillary-division herpes zoster

The answer is E. Herpes zoster is reactivation of latent varicella-zoster virus after prior chickenpox and produces painful vesicles in a unilateral dermatomal distribution. The key discriminator is that the palatal and gingival lesions are confined to one side and respect the midline. Hard-palate involvement can occur with zoster affecting the maxillary division (V2) of the trigeminal nerve, through its palatal/nasopalatine branches. Recurrent intraoral HSV can affect keratinised mucosa, including hard palate and attached gingiva, but usually lacks this strict unilateral dermatomal pattern. Primary herpetic gingivostomatitis is typically diffuse, with generalised painful gingivitis and systemic features. Erythema multiforme and hand, foot and mouth disease do not characteristically produce a unilateral trigeminal distribution.

Reference: Pelloni LS, Pelloni R, Borradori L. Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation. BMC Oral Health. 2020. https://pubmed.ncbi.nlm.nih.gov/34506415/