Burning mouth syndrome(BMS)—persistent burning pain for which no dental or medical cause is found—may be associated with herpes simplex virus (HSV) type 1 or varicella zoster virus (VZV), say clinicians at University of Colorado in Aurora. They report on 2 female patients with BMS who had elevated levels of serum anti-VZV IgM antibodies.
One patient had experienced BMS for 8 months; the other for 2 years. Routine blood counts, liver, kidney, thyroid, and other tests were normal for both patients. No VZV, HSV-1, or HSV-2 DNA were detected in saliva samples, but serum anti-VZV IgG antibody was present and anti-ZV IgM antibody was elevated at 1.88 in 1 patient and 1.02 in the other (normal < 0.90).
Both patients had received zoster vaccine within a year of the onset of BMS, but the clinicians said it “seems unlikely” that immunization contributed to their condition, because none of more than 19,000 adults who had received zoster vaccine in the Shingles Prevention Study developed BMS.
Oral valacyclovir, 1 g 3 times daily for 2 months reduced the pain to minimal for the first patient, although severe pain recurred when the dose was lowered or the drug was discontinued. The clinicians say she has continued to improve on the daily dose. The second patient also was started on oral valacyclovir 1 g 3 times daily for 3 months. Her anti-VZV IgM antibody remained elevated after 3 months. The same dose, continued for another 3 months, reduced the pain by 60%. The dose was lowered to 1 g daily. After 8 months, she is pain free for 3 to 4 days a week; otherwise, the pain is mild.
The clinicians suggest not only evaluating patients with BMS for VZV or HSV-1, but also being aware that prolonged antiviral treatment may be required.
Nagel MA, Gilden D. BMJ Case Rep. 2016; pii: bcr2016215953.