Progressive shingles in a toddler due to reactivation of Varicella Zoster vaccine virus four days after infection with SARS-CoV-2; a case report

BMC Infect Dis. 2023 Dec 6;23(1):854. doi: 10.1186/s12879-023-08809-5.

Abstract

Background: Herpes zoster (HZ) is the clinical syndrome associated with reactivation of latent varicella-zoster virus (VZV). Several factors have been implicated to promote VZV reactivation; these include immunosuppression, older age, mechanical trauma, physiologic stress, lymphopenia, and more recently, infection with severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Recent reports suggest an increase in the number of HZ cases in the general population during the global COVID-19 pandemic. However, it is unknown what proportion of HZ during the pandemic is due to reactivation of wild-type or vaccine-strain VZV.

Case: Here we report the first known case of HZ concomitant with SARS-CoV2 infection in a 20-month-old female who was treated with a single dose of dexamethasone, due to reactivation of the vaccine-type strain of VZV after presenting with a worsening vesicular rash.

Conclusion: In this case, we were able to show vaccine-strain VZV reactivation in the context of a mild acute symptomatic COVID-19 infection in a toddler. Being able to recognize HZ quickly and effectively in a pediatric patient can help stave off the significant morbidity and mortality associated with disease process.

Keywords: COVID-19; Herpes Zoster (HZ); Pediatric; SARS-CoV-2; Shingles; Varicella Zoster Virus (VZV).

Publication types

  • Case Reports

MeSH terms

  • COVID-19* / complications
  • COVID-19* / virology
  • Chickenpox Vaccine* / adverse effects
  • Female
  • Herpes Zoster* / diagnosis
  • Herpes Zoster* / drug therapy
  • Herpes Zoster* / etiology
  • Herpes Zoster* / virology
  • Herpesvirus 3, Human
  • Humans
  • Infant
  • Pandemics
  • RNA, Viral
  • SARS-CoV-2
  • Viral Vaccines / adverse effects

Substances

  • RNA, Viral
  • Viral Vaccines
  • Chickenpox Vaccine