Over the years, I have had patients come in with severe one-sided regional pains with no good reason for it to be there. In each case, I have suspected Herpes Zoster prodrome and initiated antivirals with resolution without rash. I could never know for sure if I was right, but the patients have all been happy with outcome…
very recently:
35 year old lady came in with pain in left ear rather severe enough to bring her in – with a sense of fullness in ear as well:
– ear canal and drum look fine
– movement of tragus and pina does not cause pain
– is some tender over TMJ but patient could chew without any pain and there was good jaw opening.
– draws a line with her finger over the outer extent of the pain which extends onto the cheek – so pain is suspiciously circumscribed.
– does play hockey but denies any hit to the face/jaw
– no lymph nodes, rash, fever nor chills.
– no predisposing illnesses
– no Ramsay-Hunt – ie no rash in ear with “tinnitus, deafness, vertigo, vomiting, nystagmus, and disturbance of equilibrium” as per here
Comment – I am highly suspect of any herpes zoster / shingles prodrome if:
1) Unexplained one sided pain
2) Pain relatively severe – enough to bring patient in and almost neurogenic
3) Has a nerve distribution – can draw the line where there is pain and where there is not
I have started her on herpes zoster dose of Valtrex – ie 1 gm tid for next 7 days and if gets rash add prednisone – I guess time will tell.
Any zoster stories?
Addendum –
Curr Top Microbiol Immunol. 2010 Feb 26. [Epub ahead of print]
Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash.
Gilden D, Cohrs RJ, Mahalingam R, Nagel MA.
suggests diagnosis can be made by ” Virological confirmation requires the demonstration of amplifiable VZV DNA in cerebrospinal fluid (CSF) or in blood mononuclear cells, or the presence of anti-VZV IgG antibody in CSF or of anti-VZV IgM antibody in CSF or serum.”
I have been suffering with the same left sided burning/electricity like pain in ear, face, jaw, severe stiff neck and left side of throat feels closed (most scary feeling). It all started in March when I was very lethargic for weeks and then ended up in ER because closing feeling in throat, pain in chest area and numb/burning feeling scared me and caused me to have a panic attack (I really thought my throat was closing up and I could not breath). The doctors did MRI and said I could have had a small stroke even though the tests were inconclusive. A month later I went to the ER again and did every blood test under the sun once again finding nothing. I was sent to see a Cardiologist to rule out any heart issues. Did stress test, EKG, wore heart monitor. The findings were two heart valve leaks, but nothing that would cause the pain I was having. Sick and tired of tests and no answers I decided to go to a Natural Path. The doctor did their tests and found a virus (Shingles) present in my body as well as Adrenal Fatigue. I do not remember having any rash but have read that some people never develop the rash. I am being treated with Liver and Adrenal support homopathic meds. I also realized the need to keep my stress under control (the reason for the surfacing of the virus). It is September and I still have the nerve pain and wish there was something else I could do. I am also wondering if the pain I have is now considered Post Herpetic Neuralgia….since I have had the nerve pain for almost 6 months!