Glossopharyngeal Postherpetic Neuralgia Palliated With Fluoroscopic‐Guided Nerve Block: A Case Report

CASE A 51-year-old presumably immunocompetent Caucasian woman with history of hypothyroidism, migraine, and chronic lower back pain presented to pain clinic with 4 months of right throat and ear pain. Severe, unilateral pain paroxysms (about 12 times daily) presented suddenly, followed by ipsilateral vesicles involving the right uvula, palate, tongue, and tonsillar fossa (Fig. 1A). Pain was provoked by talking and swallowing and was associated with hoarseness, dysgeusia, dysphagia, 20 pounds involuntary weight loss, and sleep interference. About twice daily, pain exacerbations with violent coughing and emesis occurred. Examination in the emergency department 6 days after onset revealed right-sided vesicles affecting the right uvula, palate, tongue, and tonsillar fossa with symmetric palatal elevation and no auditory canal or tympanic membrane lesions. Glossopharyngeal shingles was diagnosed. Treatment with valcyclovir and methylprednisolone was initiated without benefit. She later was treated with oxcarbazepine 600 mg twice a day, which caused sedation without benefit; nortriptyline 20 mg nightly was discontinued for weight gain and inefficacy, viscous lidocaine was discontinued as it triggered emesis, gabapentin was declined since previously caused sedation, pregabalin was declined due to patient’s concern regarding possible side effects, topiramate