Tjut Intan Permata Sari1, Anandina Irmagita Soegyanto2, Endah Ayu Tri Wulandari3

Oral Medicine Residency Program, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Department of Oral Medicine, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia

Division of Oral Medicine, Department of Dentistry, Dr. Cipto Mangunkusumo General Hospital/Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

Abstract

Background: Herpes Zoster (HZ) is a debilitating disease that can present extra and/or intraorally and may cause severe complications eg. multiple dermatomes, disseminated and systemic involvement. Older age and immunocompromised condition are thought to be risk factors for HZ. The incidence of HZ among HIV-infected patients who were over 50-years-old for African American and European American was 144 and 93 cases per 10,000 person-years.

Objective: To describe a Herpes Zoster case in an HIV-infected patient with Diabetes Mellitus (DM) and Hypertension comorbidities who commencing antiretroviral therapy (ART)

Case report: A 55-year-old female patient was referred from the HIV Integrated Clinic to the Oral Medicine Clinic of Cipto Mangunkusumo General Hospital with the chief complaint of an itchy and painful sensation on left lower alveolar ridge and chin for 3  days, accompanied by a headache and swollen left lower lip.

She had initiatively applied an ointment to her chin and took paracetamol for the headache. Extraorally, there were brownish yellow crust contained to the left side of the chin without crossing the mid-line. Intraorally, there were small erosive ulcers on left lower lip. The patient had been diagnosed with HIV 8 months earlier and was already on ART. She admitted having type-2 DM and hypertension long before the HIV diagnosis was established. The HZ was treated with Acyclovir 800 mg and topical application of 5% acyclovir cream 5 times a day, and Doloneurobion 3 times a day. We sent the patient for laboratory tests: CD4 cell counts, complete blood count (CBC) and blood glucose level.

Conclusion: HZ usually occurs in immunocompromised patients, including HIV-infected and diabetic ones. It is important for dental practitioners to be able to identify HZ lesions and be aware of the systemic diseases which compromise a patient's immune system, including HIV infection and DM. Dentists should know how to treat HZ in an HIV-infected patient when ART and with comorbidities.