Shingles, commonly known for its painful skin rash, can also affect areas inside the body. The varicella-zoster virus (VZV) responsible for shingles can reactivate and travel along nerve pathways to impact internal organs and systems, meaning it is not exclusively a skin condition.
The Nature of Shingles
Shingles, also known as herpes zoster, stems from the reactivation of the varicella-zoster virus (VZV), the same virus that causes chickenpox. After chickenpox, VZV becomes dormant, residing in nerve cells within the nervous system, specifically in the cranial nerves and spinal ganglia. These ganglia are clusters of nerve cells that connect the spinal cord to nerves throughout the body.
Years later, the dormant virus can reactivate, often linked to a decline in immunity due to aging, stress, or conditions that weaken the immune system. Once reactivated, the virus travels along nerve pathways from the ganglia towards the skin, typically causing the characteristic painful rash. This journey also allows it to affect internal structures connected by those nerves.
Internal Manifestations of Shingles
When the varicella-zoster virus reactivates, it can extend beyond the skin to affect various internal systems and organs, depending on the nerve pathways it travels along. This internal involvement is sometimes referred to as visceral zoster or zoster sine herpete, especially if no rash is present.
Ophthalmic shingles occurs when the virus reactivates within the trigeminal ganglion, affecting the ophthalmic nerve that supplies sensation to the eye. Otologic shingles, or Ramsay Hunt syndrome, happens when VZV reactivates in the geniculate ganglion, impacting cranial nerves like the facial nerve (VII) and vestibulocochlear nerve (VIII), which control facial movement, hearing, and balance. Visceral shingles refers to the virus affecting internal organs like the lungs, liver, gastrointestinal tract, or bladder.
Central nervous system shingles involves the virus spreading to the brain or spinal cord, potentially causing inflammation. Vascular shingles affects blood vessels, which can lead to serious complications.
Recognizing Internal Shingles Symptoms
The symptoms of internal shingles can be diverse, varying based on the affected internal area, and may not always include the typical skin rash. For instance, ophthalmic shingles can cause eye pain, changes in vision, redness, and sensitivity to light.
Otologic shingles, or Ramsay Hunt syndrome, commonly presents with ear pain, hearing loss, dizziness, and facial weakness or paralysis. When shingles affects internal organs (visceral shingles), symptoms are organ-specific; for example, abdominal pain, nausea, vomiting, or changes in bowel habits might indicate gastrointestinal involvement, while breathing difficulties could suggest lung involvement.
Central nervous system shingles can lead to severe headache, confusion, fever, stiff neck, and even seizures or motor weakness. Vascular shingles may manifest with symptoms similar to a stroke. The absence of a visible rash, known as zoster sine herpete, can make internal shingles particularly challenging to recognize, as its symptoms can resemble many other conditions.
Diagnosis and Management
Diagnosing internal shingles can be complex because the usual skin rash might be absent or subtle, and symptoms often mimic other conditions. Healthcare providers typically begin with a thorough medical history, including whether a person has previously had chickenpox. Physical examination helps identify any neurological deficits or signs of organ involvement.
To confirm the presence of the varicella-zoster virus, specific laboratory tests are used. Polymerase chain reaction (PCR) testing can detect VZV DNA in samples such as cerebrospinal fluid for central nervous system involvement. Blood tests, including enzyme-linked immunosorbent assay (ELISA), can check for VZV antibodies. Imaging techniques like MRI or CT scans may also be employed to visualize inflammation or damage in affected organs.
Treatment for internal shingles primarily involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir. These medications work best when administered early in the course of the illness, ideally within 72 hours of symptom onset, to reduce severity and prevent complications. Supportive care is also provided based on the specific organs affected, which may include pain management, anti-inflammatory medications, or specialized treatments for eye or ear involvement.
Severe Forms of Shingles
Internal shingles, if left untreated, can lead to severe and potentially life-altering complications. For example, ophthalmic shingles can result in permanent vision loss. Similarly, otologic shingles may cause lasting hearing loss or facial paralysis.
When the virus affects the central nervous system, it can lead to encephalitis, an inflammation of the brain, which may cause long-term neurological deficits or be fatal. Vascular involvement can increase the risk of stroke. Widespread infection, known as disseminated zoster, can affect multiple organs like the lungs (pneumonia) or liver (hepatitis), posing a significant threat, particularly in individuals with compromised immune systems. Prompt medical evaluation and treatment are important to mitigate these serious outcomes.