Herpes zoster reactivation after mRNA-1273 (Moderna) SARS-CoV-2 vaccination

Abstract

To the Editor: We read with great interest the recent case series by Rodríguez-Jiménez et al,1Rodríguez-Jiménez P. Chicharro P. Cabrera L.M. et al.Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: report of 5 cases.JAAD Case Rep. 2021; 12: 58-59https://doi.org/10.1016/j.jdcr.2021.04.014Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar “Varicella-zoster virus reactivation after SARS-Cov2 BNT162b2 mRNA vaccination: report of five cases.” During this unprecedented era of scientific development and rapid administration of vaccines to combat COVID-19, cutaneous reactions have been increasingly reported.1Rodríguez-Jiménez P. Chicharro P. Cabrera L.M. et al.Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: report of 5 cases.JAAD Case Rep. 2021; 12: 58-59https://doi.org/10.1016/j.jdcr.2021.04.014Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar Reports of “COVID arm,” morbilliform rashes, and delayed local cutaneous reactions have recently been added to the growing literature on COVID-19 vaccination side effects.2McMahon D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.2021.03.092Abstract Full Text Full Text PDF PubMed Scopus (609) Google Scholar Within the last 2 months, there have been a number of case reports additionally highlighting herpes zoster virus reactivation after administration of both the mRNA and inactivated versions of the COVID-19 vaccine. Both Eid et al3Eid E. Abdullah L. Kurban M. Abbas O. Herpes zoster emergence following mRNA COVID-19 vaccine.J Med Virol. 2021; 93: 5231-5232https://doi.org/10.1002/jmv.27036Crossref PubMed Scopus (75) Google Scholar and Bostan and Yalici-Armagan4Bostan E. Yalici-Armagan B. Herpes zoster following inactivated COVID-19 vaccine: a coexistence or coincidence?.J Cosmet Dermatol. 2021; 20: 1566-1567https://doi.org/10.1111/jocd.14035Crossref PubMed Scopus (99) Google Scholar observed cutaneous herpes zoster reactions after COVID-19 vaccination in male patients in their 70s. Recently, Furer et al5Furer V. Zisman D. Kibari A. Rimar D. Paran Y. Elkayam O. Herpes zoster following BNT162b2 mRNA COVID-19 vaccination in patients with autoimmune inflammatory rheumatic diseases: a case series.Rheumatology (Oxford). April 12, 2021; : keab345https://doi.org/10.1093/rheumatology/keab345Crossref PubMed Scopus (121) Google Scholar published a case series of patients with autoimmune inflammatory rheumatic diseases who presented with reactivation of herpes zoster virus after COVID-19 vaccination. We concur with Rodríguez-Jiménez et al1Rodríguez-Jiménez P. Chicharro P. Cabrera L.M. et al.Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: report of 5 cases.JAAD Case Rep. 2021; 12: 58-59https://doi.org/10.1016/j.jdcr.2021.04.014Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar that the association of cases with herpes zoster after the COVID-19 vaccination is inconclusive and potentially coincidental, but we would like to add to the literature a report of a similar case in a patient that presented to our dermatology clinic. Our patient is an 81-year-old Caucasian man with a past medical history of diabetes, hypertension, and coronary artery disease who presented with a dermatomal rash characteristic of herpes zoster 3 days after receiving the second dose of the mRNA-1273 (Moderna) COVID-19 vaccine. Interestingly, the patient had previously received 2 doses of the recombinant zoster vaccine (Shingrix; GSK), with his last dose in 2019. In addition, the patient reported having varicella as a child. At the time of presentation, the patient denied any recent trauma, medical/cosmetic procedures, medication changes, or foreign travel. His other medical history was otherwise unremarkable. No other household contacts were affected. The rash resolved 3 weeks after its initial presentation without any intervention. This patient serves as an additional example of herpes zoster reactivation after the COVID-19 vaccination. Despite subtle differences in age and presentation of the current reported cases, we believe that we can add another case to the literature to make dermatologists and other clinicians aware of this potential side effect of COVID-19 vaccination. The pathogenesis of this reaction is currently unclear, but it is possible that the immunomodulatory response generated via these vaccines may lead to the reactivation of latent herpes zoster. Rodríguez-Jiménez et al1Rodríguez-Jiménez P. Chicharro P. Cabrera L.M. et al.Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: report of 5 cases.JAAD Case Rep. 2021; 12: 58-59https://doi.org/10.1016/j.jdcr.2021.04.014Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar note that herpes zoster virus reactivation does not present as a common reaction in other current vaccination modalities. However, as clinicians, if we have learned anything from the last year, it is to expect the unexpected and adapt accordingly to provide the best care for our patients. None disclosed. Varicella-zoster virus reactivation after SARS-CoV-2 BNT162b2 mRNA vaccination: Report of 5 casesJAAD Case ReportsVol. 12PreviewA few months ago, we reported that to consider vesicular exanthems associated with COVID-19, varicella-zoster virus (VZV) and herpes simplex virus must be ruled out.1 The natural history of herpes zoster is influenced by the immune status of the host. Reactivation is influenced by age-related immunosenescence, disease-related immunocompromised state, or iatrogenic immunosuppression, with age being the major risk factor for most cases of herpes zoster. Among VZV reactivation triggers, vaccines are not common, and excluding herpes zoster appearing after VZV vaccination, we have found only 1 case of a child who experienced herpes zoster after diphtheria/tetanus/acellular pertussis, inactivated polio, Haemophilus influenzae type b, and meningococcal C vaccine. Full-Text PDF Open AccessVaricella zoster virus reactivation and mRNA vaccines as a triggerJAAD Case ReportsVol. 15PreviewTo the Editor: We read with great interest the report by Channa et al,1 “Herpes zoster reactivation after mRNA-1273 (Moderna) SARS-CoV-2 vaccination.” Currently, vaccination against SARS-CoV-2 is being carried out worldwide. As a consequence, a wide variety of cutaneous adverse effects after COVID-19 vaccination are being described.2 Over the course of the last months, a fair number of herpes zoster cases developing after the administration of COVID-19 vaccines have been reported.1-5 Full-Text PDF Open Access

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