A Case of Disseminated Herpes Zoster With Polyneuropathy Following the Third Dose of the Pfizer-BioNTech Vaccine

Riazuddin, Muhammad; Jefri, Mona H; Butt, Muhammad Imran; Alsalamah, Hathami I; Sheikh, Aamir Nadeem M Ali

doi:10.7759/cureus.33962

Cited by 2 publications

(5 citation statements)

References 13 publications

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“…Whatever the mechanism, the trigger for VZV reactivation resulting in DHZ should be consistent among different types of COVID-19 vaccinations. Indeed, this and previous studies found that DHZ could occur after the protein subunit, mRNA-based [ 6 , 7 ], viral vector [ 8 ], and inactivated vaccinations [ 9 ]. In addition, DHZ cases secondary to natural infections with SARS-CoV-2 have been reported [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 57%

“…With the addition of two cases from this study, only six cases of DHZ following COVID-19 vaccinations have been reported in immunocompetent patients [ 6 , 7 , 8 , 9 ]. The major characteristics of these cases are summarized in Table 1 .…”

Section: Discussionmentioning

confidence: 99%

“…Disseminated HZ (DHZ), a rarely severe form of HZ, is defined by the presence of >20 vesicles beyond the primary or adjacent dermatome, which typically occurs in immunocompromised persons [ 5 ]. To date, only four cases of DHZ following COVID-19 vaccinations have been reported in immunocompetent patients [ 6 , 7 , 8 , 9 ] ( Table 1 ). Among them, two cases were associated with mRNA-based vaccination [ 6 , 7 ], whereas the other two were associated with the viral vector [ 8 ] and inactivated vaccination [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…To date, only four cases of DHZ following COVID-19 vaccinations have been reported in immunocompetent patients [ 6 , 7 , 8 , 9 ] ( Table 1 ). Among them, two cases were associated with mRNA-based vaccination [ 6 , 7 ], whereas the other two were associated with the viral vector [ 8 ] and inactivated vaccination [ 9 ]. A fourth type of COVID-19 vaccine is the protein subunit vaccine containing a stable prefusion spike protein of SARS-CoV-2 [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Disseminated Herpes Zoster Following Protein Subunit and mRNA COVID-19 Vaccination in Immunocompetent Patients: Report of Two Cases and Literature Review

Lin,

Chang

2023

Medicina

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Disseminated herpes zoster (DHZ), resulting from the reactivation of the varicella-zoster virus (VZV), typically occurs in immunocompromised persons. To date, only four cases of DHZ following mRNA, viral vector, or inactivated COVID-19 vaccinations have been reported in immunocompetent patients. Herein, we present the first case of DHZ following the protein subunit COVID-19 vaccination (case 1, 64 years old) and a case of DHZ following mRNA COVID-19 vaccination (case 2, 67 years old) in elderly, immunocompetent male patients. Both cases were generally healthy, without a remarkable underlying disease and without a history of immunosuppressant use. Case 1 developed DHZ (left C3–5 predominant) 1 month after receiving the third dose of the SARS-CoV-2 spike protein vaccine (MVC-COV1901). Case 2 developed DHZ (right V1–3 predominant) 7 days after receiving the second dose of the mRNA-1273 SARS-CoV-2 vaccine. Through skin examination, Tzanck smears, and dermoscopy, the diagnosis of COVID-19 vaccination-related DHZ was established in both cases. Oral famciclovir (250 mg, three times/day for 7 days) was administered, and both cases achieved total remission of skin lesions without visceral involvement or severe post-herpetic neuralgia. Our cases demonstrate that DHZ, as a rare cutaneous adverse event in immunocompetent patients, can be secondary not only to mRNA COVID-19 vaccination but also to the protein subunit COVID-19 vaccination. It is speculated that the spike protein of SARS-CoV-2 could be the common trigger for the reactivation of VZV among different types of vaccinations.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Disseminated Herpes Zoster Following Protein Subunit and mRNA COVID-19 Vaccination in Immunocompetent Patients: Report of Two Cases and Literature Review

Lin,

Chang

2023

Medicina

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“…Disseminated HZ was more likely to be reported in patients with recent COVID-19 vaccinations than in controls; however, this finding was not statistically significant. Several previous studies have reported that HZ was disseminated after COVID-19 vaccination, including inactivated vaccines, nonreplicating viral vectors, and mRNA vaccines, in patients older than 65 years of age or in immunocompromised hosts [ 47 – 51 ]. However, this study reported that only one patient with disseminated HZ after vaccination was immunocompromised, and only 28.6% of patients were older than 65 years of age.…”

Section: Discussionmentioning

confidence: 99%

Herpes Zoster after COVID-19 Infection or Vaccination: A Prospective Cohort Study in a Tertiary Dermatology Clinic

Leeyaphan,

Jirawattanadon,

Bunyaratavej

et al. 2023

Dermatology Research and Practice

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Background. Herpes zoster (HZ) has been observed to occur after COVID-19 infection and vaccination; however, knowledge regarding the demographic data, clinical presentations, and treatment outcomes of HZ is limited. Objective. To compare the demographic data, clinical manifestations, treatments, and outcomes of patients with and without HZ within 14 days of COVID-19 infection or vaccination. Methods. This prospective cohort study involving patients diagnosed with cutaneous HZ was conducted at a dermatology clinic from October 2021 to January 2023. Results. Among a total of 232 patients with HZ, the median age was 62.0 years and 59.1% were female. HZ developed in 23 (9.9%) and four (1.7%) patients after COVID-19 vaccination and infection, respectively. The mean duration from vaccination and the median duration from infection to HZ onset were 5.7 and 8.5 days, respectively. The proportion of female patients was significantly higher in the group of patients with COVID-19 vaccination or infection than in those without such a history (P = 0.035). Patients who developed HZ following the recent COVID-19 infection had a median age of 42.5 years, which was lower than that of the other groups. Dissemination occurred in 8.7% of the patients after COVID-19 vaccination. HZ recurrence was reported in five cases, of which 80% had been vaccinated or infected with COVID-19 during the previous 21 days. All patients had similar durations of antiviral treatment, crust-off time, and duration of neuralgia. Conclusions. HZ after COVID-19 vaccination is more frequently observed in females, while HZ after COVID-19 infection tends to occur in younger patients. Disseminated HZ is more common in patients recently vaccinated against COVID-19. COVID-19 vaccination or infection may trigger recurrent HZ infection.

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A Case of Disseminated Herpes Zoster With Polyneuropathy Following the Third Dose of the Pfizer-BioNTech Vaccine

Cited by 2 publications

References 13 publications

Disseminated Herpes Zoster Following Protein Subunit and mRNA COVID-19 Vaccination in Immunocompetent Patients: Report of Two Cases and Literature Review

Disseminated Herpes Zoster Following Protein Subunit and mRNA COVID-19 Vaccination in Immunocompetent Patients: Report of Two Cases and Literature Review

Herpes Zoster after COVID-19 Infection or Vaccination: A Prospective Cohort Study in a Tertiary Dermatology Clinic

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