Oral Herpes Zoster Infection Following COVID-19 Vaccination: A Report of Five Cases

Abstract

Recently, two cases of oral herpes zoster (HZ) following COVID-19 vaccines were reported. It was suggested that COVID-19 vaccine-related oral HZ cases might be missed or misdiagnosed as stomatitis or isolated oral herpes. In this report, five cases of oral HZ following COVID-19 vaccinations are presented. Four cases were observed on the hard palate (V2), and one case was found on the mandible (V3). Four patients did not receive any treatment for their oral HZ, but one patient also had skin reactions on her right orbit and ear and was thus treated with an antiviral drug. As these cases were seen during such a short period of time and in one practice, the relationship with the COVID-19 vaccination appears to be related.

Potential risk factors for Varicella‐zoster virus reactivation after COVID‐19 vaccination

“…We analyzed 93 cases of VZV reactivation following the COVID‐19 vaccine reported in literature. 1 , 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 We decided to focus only on cases with enough information to allow for a correct risk assessment, for example, we did not include all the reports where age or sex were not present. There was no significant difference between males and females (44 men vs 49 women), and, in accordance with the previous observations, 3 the majority of the VZV reactivations were secondary to mRNA vaccines (46 following Pfizer's BNT162b2 and 19 following Moderna's mRNA‐1273 vs 18 following Astrazeneca's AZD1222 (ChAdOx1), 2 following Johnson & Johnson's JNJ‐78436735 (Ad26.COV2.S), 1 following Bharat Biotech's BBV152 (Covaxin), 1 following Sinopharm's BBIBP‐CorV vaccine (Vero Cells), and 1 following Sputnik V (Gam‐COVID‐Vac); 5 not specified).…”

Oral lesions after COVID-19 vaccination: Immune mechanisms and clinical approach

“…On the other hand, side effects may represent a complication of COVID-19 disease in patients who already have a concomitant with SARS-CoV-2. Some studies have shown that COVID-19 might be a potential trigger for OLP [10] , and it can also reactive VZV [29] . Physicians and dentists should consider that the mentioned oral lesions could be a complication of either COVID-19 infection or vaccination.…”

“… A reduction in lymphocytes, especially CD3+ CD8+ lymphocytes, which can occur during infection with SARS‐CoV‐2, has been proposed as a potential mechanism triggering reactivation of herpesviruses. Fukuoka H., et al [29] Report of five cases Five Japanese patients (four females and one male), whose age range was 59-97 years BNT162b2 First and second dose Oral herpes zoster Unilateral acute rash Ranged from 1 to 3 weeks - Four patients did not receive any treatment for their oral HZ, but one patient also had skin reactions on her right orbit and ear and was thus treated with an antiviral drug. - …”

“…It can happen from 2 days to 38 days after the vaccine administration. Symptoms included a cluster of fluid-filled lesions on the face, multiple unilateral small ulcers in the mouth and one-sided facial droop ([ 28 , 29 , 36 ]).…”

“…VZV can also be reactivated with symptomatic COVID-19 [29] . The SARS-Cov-2 virus causes immune dysfunction and decreased body resistance to infections, therefore, it may lead to oral HZ [37] .…”