Stellate ganglion block using procaine in the treatment of herpes zoster ophthalmicus with keratitis after root canal treatment and post-herpetic pruritus in the third trimester of pregnancy and early lactation: a case report and review of the literature.

INTRODUCTION

Herpes zoster results from the reactivation of the varicella zoster virus, which rarely occurs during pregnancy. This condition increases maternal morbidity, and the main complications are herpes zoster ophthalmicus and post-herpetic neuralgia. This report presents the first known case of herpes zoster ophthalmicus with keratitis after a root canal procedure and post-herpetic pruritus in the third trimester of pregnancy and early lactation. Neural therapy was used as a complementary treatment, known for its analgesic and anti-inflammatory effects.

CASE PRESENTATION: A 41-year-old multigravida in the 28th gestational week, without prodromal symptoms, developed a characteristic herpes zoster ophthalmicus rash 1 day after undergoing an upper-right 7-tooth root canal. Within the first 3 days of the first blister, the patient was hospitalized and administered intravenous and topical acyclovir as a state-of-the-art treatment to alleviate symptoms and help the keratitis subside. After hospitalization, the patient experienced severe acute herpes zoster pain accompanied by itching and numbness. In addition to oral and topical acyclovir and paracetamol therapy, intra- and subcutaneous neural therapeutic injections of 1% procaine in the temporal and supraorbital regions and a stellate ganglion block were administered as potential treatment methods to improve quality of life. The decrease in pain and itching was measured using the Numeric Rating Scale. After 4 weeks, severe pain ceased, and after 8 weeks, severe itching disappeared during the breastfeeding period. Neither pain nor itching recurred during the 47-month-long follow-up.

CONCLUSION

Although the self-limiting course of shingles has minimal effects on the fetus, maternal complications can cause a significant burden. Data on the treatment of herpes zoster ophthalmicus during pregnancy and lactation are limited. Acyclovir and paracetamol-as important pillars of the treatment-were supplemented with neural therapy, which included stellate ganglion blocks. Due to the limitations of the case report, neural therapy should be confirmed in large clinical trials as a complementary method for herpes zoster ophthalmicus during pregnancy.