Study Examines Herpes Zoster Reactivation Following COVID-19 Vaccination

A new study examined 3 different cases of chronic urticaria being treated with cyclosporine and patients who developed reactivation of recurrent herpes zoster (HZ) following COVID-19 vaccination.

Each patient developed HZ within a week of receiving the first dose of the COVID-19 vaccine and had a case of chronic spontaneous urticaria being treated with capsule cyclosporine for at least 1 month. Thoracic dermatomes were involved in 2 patients, whereas 1 patient had cervical dermatomal involvement. Further, all 3 patients had developed similar lesions consistent with HZ in the past, according to the study, which was published in the Journal of Cosmetic Dermatology.

Case 1 analyzed a 34-year-old male who experienced a similar episode of HZ 7 months prior over the same site. The examination showed the presence of necrotic ulceration confined to the right T1-T2 dermatome. The lesions had turned into painful stabbing pain 7 days after vaccination and caused erosion and ulceration in the surrounding skin.

In case 2, a 57-year-old male had HZ opthalmicus with painful vesicular eruptions and purulent discharge from the right eye with intense swelling of unilateral eyelid. The previous HZ episode happened 5 years previously on the right side of the thorax.

In case 3, a 38-year-old male had HZ of the T4-T5 dermatomes, which had erupted 4 days following immunization. This patient was already being treated for residual post-herpetic neuralgia, which had developed from an episode of HZ involving the left thorax that occurred 1 year prior.

The patients were treated with T. Valacyclovir 1gm TDS for 7 to 10 days, along with Cap pregabalin and nortriptyline or carbamazepine followed by complete recovery in skin lesions, and all 3 had a negative serological profile for any acquired immunosuppression. Cases 1 and 2 were given tablet prednisolone 60 mg in tapering dose for over 14 days, with the drug being used to treat different inflammation and nerves that would occur from the tablet, according to the study authors.

Cases 2 and 3 failed to show any persistent response with a high dose of antihistaminics and steroids, whereas case 1 had received autologous serum therapy with little to no improvement. The duration of consumption of cyclosporine in our cases prior to onset of RHZ ranged from 5 to 8 weeks. In all 3 cases, the symptoms of HZ were mild to moderate with complete resolution of the condition within a month.

This most recent observation in these 3 cases is contrasting to the recent research that states HZ recurrence to be more common in elderly patients. According to the study authors, this is the first case series of recurrent varicella-zoster virus following COVID-19 vaccination with a strong clinical suspicion of iatrogenic immunosuppression due to cyclosporine. Larger case studies over longer periods of time are recommended for any future studies involving this subject.

REFERENCE

Arora A, Mehta RD, Mohta A, Srinivasa R. Recurrent herpers zoster after COVID-19 vaccination in patients with chronic urticara being treated with cyclosporine- a report of 3 cases. Journal of Cosmetic Dermatology. September 12, 2021. Accessed September 24, 2021.https://doi.org/10.1111/jocd.14437