A rare case of shingles after COVID-19 vaccine: is it a possible adverse effect?

Abstract

Coronavirus disease 2019 (COVID-19) exhibit mild to moderate symptoms, whereas 15% of COVID-19 cases progress to pneumonia, some associated cutaneous findings are also reported as maculopapular eruptions, morbilliform rashes, urticaria, chickenpox-like lesions, and livedo reticularis. The inactivated COVID-19 vaccines are authorized for use in some countries including Turkey. Here, we report an unusual case of varicella-zoster virus (VZV) reactivation in a 68-year-old male patient who was vaccinated against COVID-19. The patient presented to family medicine clinic with a stinging sensation and pain radiating from the right side of his chest to his back. Physical examination revealed multiple pinheaded vesicular lesions upon an erythematous base occupying an area on his right mammary region and back corresponding to T3–T5 dermatomes. He reported that he got his second dose of COVID-19 vaccine 5 days ago. As COVID 19 decreases the cell-mediated immunity, it could also increase the risk of herpes zoster (HZ). Although the exact reason remains unsolved, vaccine-induced immunomodulation caused by live attenuated vaccines and attenuated alloreactivity caused by inactivated vaccines may be responsible mechanisms for the reactivation of HZ. Epidemiological studies are needed to clarify the possible connection between vaccination and reactivation of herpesvirus infections.

Can SARS‐CoV‐2 vaccine increase the risk of reactivation of Varicella zoster? A systematic review

“…The search yielded a total of 54 patients consisting of 27 male and 27 females. Cases were reported worldwide including USA, 10 , 11 Lebanon, 12 Turkey, 13 , 14 , 15 Greece, 16 Italy, 17 India, 18 Israel, 19 Finland, 20 Taiwan, 21 Spain, 22 and Portugal. 23 There were cases with known risk factors for herpes zoster, which included age more than 50 years ( n = 36), immunological disorders ( n = 10), chronic disease ( n = 25), metabolic disorder ( n = 13), malignancy ( n = 4), and psychiatric disorder ( n = 2).…”

“…9 , 10 Toll‐like receptors (TLR) stimulation of innate immunity might be the connection between COVID‐19 vaccine and HZ development. 15 The stimulation of these receptors has been related to the reactivation of VZV, allowing the latent virus to remain dormant in the afflicted people. 14 The COVID‐19 immunization may lead to the production of type I IFNs and other inflammatory cytokines, activating T‐ and B‐cell immunity and negatively affecting antigen expression, resulting in herpes zoster reactivation.…”

A narrative review and clinical anatomy of herpes zoster infection following COVID‐19 vaccination

“…In this review, we found that the reactivation of VZV following the COVID‐19 vaccines has been reported all over the world and with different types of vaccines. Reactivation of VZV following the vaccination using inactivated COVID‐19 has only been reported in India and Turkey (Aksu & Öztürk, 2021 ; Arora et al, 2021 ; Bostan & Yalici‐Armagan, 2021 ; Özdemir et al, 2021 ). The affected age had a wide range (21–94 year old) with a mean of 58.9 years.…”

Herpes zoster in an immunocompetent infant with a history of varicella in early infancy and after a minor injury - case report and literature review

“…Another possible mechanism may be local immunity impairment by direct trauma and subsequent immune escape of latent virus [10]. Reactivations of VZV after different types of vaccines (vaccine against influenza, hepatitis A, rabies, Japanese encephalitis, and COVID-19) were described in adult patients [12,13,14], but to the best of our knowledge HZ after hepatitis B vaccine was not reported yet. Immunomodulation after hepatitis B vaccine was observed [15], but there is weak evidence that hepatitis B vaccine contributed to VZV reactivation in our case.…”