水痘-带状疱疹病*感染_NEJM音频听写
Varicella–zostervirusinfection
A78-year-oldmanwasadmittedforarashontheforeheadandfrontalscalpandedemaofthelefteyelids.3daysearlier,pressurelikepaindevelopedintheleftsideoftheforeheadandfrontalscalpandthebilateralmaxillarysinusesandupperjaws.Thenextdaythepatientnotederythemaandsmallreddish-brownskinlesionsontheleftsideoftheforeheadandfrontalscalp.
Onthedayofpresentation,thepatientawokefromsleepandnotedrednessandswellingofthelefteyelids.Theskinlesionsontheleftsideoftheforeheadandfrontalscalphadincreasedinnumber,andsomewerecoveredwithhemorrhagiccrust.Hedescribedpainwithmovementofthelefteyeandblurryvision.Overthecourseofseveralhours,theswellingofthelefteyelidsworsenedandthepatientwasunabletofullyopenthelefteye.Hepresentedtotheemergencydepartment.
Empiricaltreatmentwithvalacyclovir,amoxicillin–clavulanate,andtopicalbacitracin–polymyxinBwasstarted.Thenextday,theedemaanderythemaofthelefteyelidsworsened,andtherewasnewedemaanderythemaoftherighteyelids.Thepatientcouldnolongertoopenhiseyes.Hebegantohavevisualhallucinationsandconfusion.Newroundpunched-outerosionswithoverlyinghemorrhagiccrustwerepresentontherightsideoftheforehead.
Thedifferentialdiagnosisforprogressiveskinlesionsisbroad,butthelocationaroundtheeyenarrowstherangeofpossibilitiesinthiscase.Inthispatient,the