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Necrotic Herpes Simplex Virus Infection of the Nose and Orbit

Dryden, Stephen C., M.D.; Fleming, James C., M.D., F.A.C.S.

Ophthalmic Plastic & Reconstructive Surgery: January/February 2019 - Volume 35 - Issue 1 - p e21–e22
doi: 10.1097/IOP.0000000000001288
Case Reports
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This is the first reported case of necrotizing nasal and sinus herpes infection with orbital involvement. A 94-year-old male with a past medical history of hypertension, congestive heart failure, and chronic kidney disease presented with necrotic nasal cellulitis and a red left eye with blurry vision. Onset was 2 weeks prior with an upper lip fever blister. He was admitted to medicine and started on antimicrobials. Maxillofacial computed tomography scan revealed pansinusitis with involvement of bilateral medial orbital walls. Initial nasal biopsy was negative. Repeat biopsy was positive for herpes simplex virus 1. His nose was debrided with full-thickness skin grafting. While there are reports of necrotizing herpes simplex, none were to the extent of our patient nor raised suspicion for invasive fungal sinusitis. Differentiating is important as this patient made a full recovery in comparison to patients with mucormycosis where mortality is often as high as 80%.

Clinical suspicion and diagnosis are important in cases of suspected fungal sinusitis as there is often a high mortality rate.

Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A.

Accepted for publication October 29, 2018.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Stephen C. Dryden, M.D., Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 470, Memphis, TN 38163. E-mail: sdryden1@uthsc.edu; and James C. Fleming, M.D., Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, 930 Madison Avenue, Suite 470, Memphis, TN 38163. E-mail: jflemin4@uthsc.edu

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.