Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

Tabrizi, Reza; Dehghani Nazhvani, Ali; Vahedi, Amir; Gholami, Mehdi; Zare, Raziyeh; Etemadi Parsa, Raha

Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

Document Type : Original Article

Authors

Reza Tabrizi ¹

Ali Dehghani Nazhvani ²

Amir Vahedi ³

Mehdi Gholami ⁴

Raziyeh Zare ⁵

Raha Etemadi Parsa ⁵

¹ Dept. of Craniomaxillofacial Surgery, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran.

² Dept. of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran.

³ Dept. of Pathology, Tabriz University of Medical Science,Tabriz, Iran.

⁴ Dept. of Maxillofacial Surgery, Mashhad University of Medical Science, Mashhad, Iran.

⁵ Postgraduate Student of Oral and Maxillofacial Pathology, Shiraz University of Medical Science, Shiraz, Iran.

Abstract

Statement of the Problem: Alveolar bone necrosis induced by Herpes zoster infection is considered as a rare manifestation of osteomyelitis and few case reports are presented in the literature.Purpose: The aim of this study was to evaluate mandibular osteomyelitis caused by herpes zoster in the immunocompromised patients with histopathologically documented osteomyelitis in the mandible and herpes zoster infection.Materials and Method: 30 patients were recruited in this cross-sectional study. 19 patients were completely edentulous, 4 patients were partially edentulous and 7 with complete dentition. In all cases, specimens were analyzed using a conventional polymerase chain reaction (PCR) test for varicella zoster virus. Results: 16 patients underwent dialysis, 9 patients received chemotherapy treatments and 5 patients had transplantation (four kidneys and one liver). Histopathological assessment demonstrated a nonspecific bone necrosis exhibiting an eosinophilic, homogeneous non-vital bone tissue with peripheral resorption surrounded by reactive connective tissue. PCR test was positive in 21 cases.Conclusion: This study demonstrated that the frequency of osteomyelitis induced by herpes zoster could be more than the records provided by previous studies. Histopathological findings might be nonspecific in such patients. PCR test was not positive for all HZ induced osteomyelitis patients.Key Words: Zona; Osteomyelitis; Mandible; Herpes zoster