Herpes Zoster Following a Nucleoside-Modified Messenger RNA COVID-19 Vaccine.

Herpes zoster (HZ) was suspected as a predictive cutaneous manifestation of COVID-19, with a debated prognostic significance. We report a series of 5 cases of HZ occurring after vaccination with a nucleoside-modified messenger RNA (mRNA) COVID-19 vaccine (Comirnaty, Pfizer-BioNTech). These new cases do not prove causality between COVID-19 vaccination and HZ. The pathophysiologic mechanism remains elusive, but local vaccine-induced immunomodulation may be involved. The occurrence of HZ does not justify avoiding the second injection of vaccine due to the benefit of vaccination.

Zoster Cranial Polyneuropathy in a COVID-19 Patient.

BACKGROUND Ramsay Hunt syndrome is a rare form of herpes zoster caused by the reactivation of the varicella-zoster virus in the geniculate ganglion. The main clinical manifestations are peripheral facial palsy, vesicular rash in the ear, and ipsilateral auricular pain, and sometimes vertigo. COVID-19 is a new multisystemic infectious disease that, in addition to common respiratory manifestations, it is known to affect the immune system, primarily depressing cellular immunity. CASE REPORT A 54-year-old woman was admitted to our hospital with an acute vestibular syndrome and diplopia. She had been diagnosed 3 years prior with interstitial lung disease for which she was taking methylprednisolone. At admission, she tested positive for SARS-CoV-2. In the following days, she developed a sixth nerve palsy on the left side and a right peripheral facial palsy on the right side, followed by a typical zoster rash on the ipsilateral ear. One month later, she developed acute severe hearing loss on the right side. There were no COVID-19 symptoms during her stay in our hospital. The MRI showed Gd enhancement of both facial nerves. Under antiviral and corticoid treatment, the evolution was favorable, with marked improvement at 6 months. CONCLUSIONS COVID-19 increases the risk for herpes zoster infection, probably through induced depression of the cellular immunity. Our case suggests Ramsay Hunt syndrome can be the presenting symptom and sometimes the only symptom of COVID-19. This also seems to be true for other cranial neuropathies, and we recommend testing these patients even if there are no other manifestations.

Varicella zoster virus-induced neurological disease after COVID-19 vaccination: a retrospective monocentric study.

The description of every possible adverse effect or event related to vaccines is mandatory during the ongoing worldwide COVID-19 vaccination program. Although cases of cutaneous varicella zoster virus (VZV) reactivation after COVID-19 vaccination have been increasingly reported in literature and database sets, a description of VZV-induced neurological disease (VZV-ND) is still lacking. In the present study, we retrospectively evaluated patients admitted to our clinic and diagnosed with VZV-ND during the COVID-19 vaccination campaign (January-April 2021) and in the same months in the previous two years. We identified three patients with VZV-ND after COVID-19 vaccination and 19 unvaccinated VZV-ND cases as controls. In the case-control analysis, the two groups showed no difference in clinical features, results of diagnostic investigations, and outcome. Thus, VZV reactivation with neurological involvement might be a possible event triggered by COVID-19 vaccination, but the benefit following COVID-19 vaccination overcomes significantly the potential risk associated with a VZV reactivation.

Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient.

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

A case of varicella zoster virus meningitis following BNT162b2 mRNA COVID-19 vaccination in an immunocompetent patient.

We report a case of varicella zoster virus (VZV) meningitis following BNT162b2 mRNA COVID-19 vaccination in an immunocompetent patient. A final diagnosis was made based on identification of VZV via positive polymerase chain reaction of cerebrospinal fluid along with characteristic symptoms such as fever, headache, and stiff neck. This phenomenon has been reported elsewhere; this is the 13th such case reported worldwide and the 7th case in immunocompetent patients, indicating the need for careful monitoring after COVID-19 vaccines.

COVID-19 pandemic as a risk factor for the reactivation of herpes viruses.

The appearance on the skin of herpes virus lesions, concomitantly with the coronavirus disease 2019 (COVID-19) pandemic, leads us to suspect an underlying infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Diagnostic reverse transcriptase polymerase chain reaction tests and immunoglobulin M (IgM) and IgG seroconversion studies have therefore been carried out. We present three cases of herpes virus infections in immunocompetent patients: one of the infections was herpes simplex 1 in a 40-year-old woman, and the other two were herpes varicella-zoster infections in a 62-year-old man and a 25-year-old woman. The patients were in the care of the southern health district of Seville of the SAS (Andalusian Health Service) during the Spanish state of alarm over the COVID-19 pandemic. The SARS-CoV-2 infection was confirmed in only one of the three cases. In this study, we briefly review the etiopathogenic role of the COVID-19 pandemic situation, whereby immunodeficiencies are generated that favour the appearance of other viral infections, such as herpes virus infections.

Case report: aseptic meningitis secondary to varicella-zoster virus (VZV) without an exanthem post MMR vaccination.

BACKGROUND: Varicella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV. CASE PRESENTATION: We report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala. CONCLUSION: This case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).

Herpes zoster after COVID vaccination.

COVID-19 presents in various ways, but mainly as a pulmonary disease (Marzano, 2020). Skin manifestations have been reported, including reactivation of the varicella-zoster virus (Marzano, 2020). Our case report describes two adults developing herpes zoster after vaccination with tozinameran (the Pfizer-BioNTech COVID-19 mRNA vaccine). A possible cause for this reaction is a transient lymphocytopenia that occurs after the vaccination - similar to that in COVID-19 disease (Mulligan, 2020; Wang, 2020; Qin, 2020; Brabilla, 2020; Wang, 2020; Wei, 2017). In the context of vaccinating older and/or immunocompromised adults, our observations can be the starting point for further evaluation of a possible relationship between COVID-19, COVID vaccines, and herpes zoster.

Herpes Zoster Following COVID-19 Vaccination.

Vaccination is an important intervention in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Messenger RNA (mRNA) vaccines from Pfizer™ and Moderna™ are the first to market in the United States, and while cutaneous adverse events have been reported in clinical trials for both of these vaccines, they have not been well characterized. Here we report a case of a patient who developed herpes zoster after receiving the Moderna™ COVID-19 vaccine. Dermatologists should familiarize themselves with this and other potential cutaneous adverse events associated with COVID-19 vaccination. J Drugs Dermatol. 2021;20(8):898-900. doi:10.36849/JDD.6146.

Herpes zoster may be a marker for COVID-19 infection during pregnancy.

Varicella-zoster virus infection causes 2 distinct forms of disease: varicella (commonly known as chickenpox) and herpes zoster (HZ)(commonly known as shingles). Primary varicella-zoster virus infection results in the diffuse vesicular rash that is characteristic of chickenpox. Following primary infection, varicella-zoster virus remains dormant in the dorsal root ganglia. This latent phase usually lasts for several decades before reactivation occurs. Varicella-zoster virus reactivation normally presents as HZ in middle-aged adults. A number of cutaneous skin manifestations have appeared in relation to the newly diagnosed coronavirus disease 2019 (COVID-19) pandemic and continue to emerge every day. We report a case of HZ complication in a COVID-19-positive woman who was 27 weeks pregnant.

Frequency of putative enteric zoster diagnosed using saliva samples in patients with abdominal pain: a prospective study.

BACKGROUND: Varicella-zoster virus (VZV) infects and establishes latency in neurons in the ganglia of the cranial nerve, dorsal root and enteric ganglia. VZV reactivation in enteric neurons (enteric zoster) can cause non-specific abdominal pain and/or serious gastrointestinal dysfunction without cutaneous manifestations. Detection of VZV DNA in saliva may be useful for identifying enteric zoster. We evaluated the frequency of putative enteric zoster based on the presence of salivary VZV DNA in patients with acute abdominal pain. METHODS: Adult patients who visited the emergency room due to moderate to severe acute abdominal pain were prospectively enrolled at a tertiary hospital between May 2019 and November 2019. Abdominopelvic computed tomography (APCT) was performed in all patients. We also evaluated the presence of salivary VZV DNA in patients with confirmed coronavirus disease-19 (COVID-19) who were under stressful conditions. Saliva samples were collected from all studied patients. Enteric zoster was suspected based on the presence of salivary VZV DNA, detected using real-time polymerase chain reaction (PCR). RESULTS: Fifty patients with moderate to severe abdominal pain were enrolled. Five of 50 patients exhibited positive VZV-DNA PCR results. APCT revealed that among these five patients, two had pancreatic head cancer, two had small bowel obstruction after intra-abdominal surgery, and one had no remarkable findings. However, all 14 patients with COVID-19 showed negative salivary VZV-DNA PCR results. CONCLUSIONS: Approximately 10% of patients with moderate to severe acute abdominal pain showed positivity for salivary VZV DNA. Further studies are warranted on whether antiviral therapy based on salivary VZV-DNA PCR results may relieve abdominal pain in the studied patient population. TRIAL REGISTRATION: clinicaltrial.gov, number NCT03862092.