A unique case of recurrent asystole secondary to paroxysmal pain of acute herpetic ophthalmicus.

Abstract

Postherpetic neuralgia is considered to be the most common and debilitating complication of acute herpes zoster and its incidence and duration of symptoms increase with age. We describe an unusual, but life-threatening complication of postherpetic neuralgia. The following case report is the first to describe a patient who developed unexpected asystolic episodes as a result of complicating pain secondary to acute herpetic ophthalmicus. The underlying pathogenesis of her cardiovascular disturbance coinciding with her painful paroxysms is unclear. This uncommon phenomenon may be explained by an exaggerated vasovagal response or even by the oculocardiac reflex rarely observed outside ocular or maxillofacial surgery. Her severe paroxysmal pain and asystole were eventually managed with oxycontin, amitriptyline, gabapentin, and intranasal fentanyl spray.