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This is a case report of a patient seen on the dental emergency clinic that describes ophthalmic shingles reactivation soon after a tooth extraction with the potential to have led to a misdiagnosis of the condition. This can potentially have serious consequences, including effects on vision. This case report emphasizes the importance of a thorough history and careful examination when a patient presents in an urgent setting.
CPD/Clinical Relevance:
The importance of a thorough history and careful examination is highlighted.
Article
A 50-year-old female patient presented post-operatively at the dental emergency clinic with a significant facial swelling affecting her left upper cheek and peri-orbital area. Relevant medical history included treatment for long-standing rheumatoid arthritis with methotrexate.
The patient had initially attended 9 days prior for an extraction of the UL6 owing to irreversible pulpitis, and then again 5 days post-operatively because of the worsening pain. At this point, the suppuration from the socket led to a diagnosis of a post-operative infection, and which was managed with socket irrigation and oral antibiotics.
On the third visit to the clinic, 9 days post-extraction (and therefore, 4 days after starting antibiotics), the patient complained of swelling around her eye, which had been getting worse for a few days and the eye was now difficult to open (Figure 1). She also complained of ‘spots which have stuff coming out of them’ on the face, referring to a clear discharge. The patient felt sure that the extraction had caused the swelling.
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