Herpes zoster ophthalmicus (HZO) is a manifestation of varicella-zoster virus reactivation involving the ophthalmic division of the trigeminal nerve and carries a risk of significant ocular complications. Early antiviral therapy may alter the clinical course of infection and occasionally produce atypical or abortive presentations. This report describes the case of a 34-year-old primigravid woman at 33 weeks of gestation with primary antiphospholipid antibody syndrome on anticoagulation therapy who presented with acute severe burning pain over the right forehead and scalp followed by grouped erythematous papules along the ophthalmic dermatome. Oral valacyclovir was initiated within eight hours of rash onset. The lesions evolved into erythematous, edematous plaques without vesiculation, pustulation, or crusting and resolved completely without ocular involvement or postherpetic neuralgia. The patient subsequently delivered a healthy neonate at term without complications attributable to maternal infection or antiviral therapy. This case demonstrates that ultra-early antiviral therapy may attenuate viral replication and modify lesion morphology and is associated with an abortive non-vesicular presentation. Recognition of this variant is important to ensure timely diagnosis and management, particularly in a high-risk pregnancy.
Donna May A Sarenas (2026) studied this question.