Background: Involvement of trochlear nerve during Varicella Zoster Virus (VZV) Infection has been rarely described, and always in association with skin rash.

Case Presentation: We describe the case of a patient with VZV infection presenting as isolated diplopia due to fourth cranial nerve palsy. The diagnosis has been obtained through the application of a standardized molecular diagnostic panel, and diplopia resolved after specific antiviral and corticosteroid therapy.

Conclusion: This case evidences that clinicians should be aware of atypical VZV infection, even in the absence of the typical skin rash.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605254PMC
http://dx.doi.org/10.1186/1471-2334-13-138DOI Listing

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