LAUSR

A 61-years-old man was admitted to the Emergency Department (ED) with a 5-day history of right facial swelling, ipsilateral pain and swallowing difficulties. Two days prior to ED evaluation, he had consulted his general practitioner who prescribed a course of antibiotics for the suspicion of bacterial skin infection. The patient’s past medical history included type 2 diabetes mellitus, hypertension and kidney transplantation for autosomal dominant polycystic kidney disease (2 years before the current ED admission). He was regularly taking immunosuppressive drugs, in particular sirolimus and methylprednisolone. On physical examination, we observed right-sided facial oedema and erythema, associated with small vesicles on the upper lip (Fig. 1). The neurological examination showed no abnormal findings; in particular, cranial nerve function was preserved. Similarly, otoscopy demonstrated no pathological signs. Upon inspection of the oral cavity, multiple white vesicles were visible on the right side of the hard and soft palate, with a distinct demarcation along the midline (Fig. 1). These clinical findings suggested orofacial acute Herpes Zoster infection of the trigeminal nerve, whereas physical examination ruled out facial nerve involvement (as in RamsayHunt syndrome). The Ear Nose and Throat team excluded the presence of laryngeal oedema using fibroscopy. Ocular examination showed only conjunctival haemorrhage. The patient was admitted to the hospital and treated with intravenous acyclovir, analgesics and a multivitamins B complex. Two weeks following admission, he was discharged in good clinical condition.