Age: 63.0
Sex: M
Vaccine: VARZOS
Symptoms: Night sweats, Pruritus, Rash papular, Rash pustular, Skin lesion
Clinical narrative: Information has been received from a physician concerning a 64 year old male anesthesiologist who on an unspecified date was vaccinated with a dose of ZOSTAVAX (Merck) (LOT# not reported). On an unreported date, the patient developed lesions similar to herpes simplex. The patient has 2 to 3 cm oval vesicular lesions scattered throughout the body. The patient also complained of itching and "myopathy". No further information was available at the time of this report. Follow up information has been received from the physician concerning the 63 year old (previously reported as 64 year old) male anesthesiologist with no allergies and with a history of chickenpox in May 1950-1951 who on 17-SEP-2008 was vaccinated in the left arm with a 0.5mL dose of ZOSTAVAX (Merck). Concomitant therapies included: LORTAB, MOTRIN, aspirin and TOPROL. On 15-MAY-2009, the patient experienced 3 vesicular lesions distributed on his left thumb, left forearm and right cheek, this was proceed by myopathy of the left arm and malaise. There was no recent exposure to chicken pox or herpes zoster, and there was no rash at the site of injection or elsewhere within 42 days of vaccination. The patient had night sweats for 3-4 days. The patient was enrolled in the Varicella Zoster Virus Identification Program to identify if VZV was present and if it was present, to identify if it was associated with the wild-type (WT) VZV strain or with the OKA/Merck vaccine strain. A lesion sample was collected on 05-AUG-2009 and sent to the lab on 06-AUG-2009. The sample was taken from a vesicular lesion on the patient's right cheek; the rash type was herpes vesicular. There was no direct fluorescent antibody done. The specimen arrived to the lab on 07-AUG-2009. At the time of the report, the patient recovered on an unspecified date. The PCR result from the vesicular specimen was negative for b-globin. The specimen was inadequate and no strain ID. The VZV DNA and B-globin DNA was not amplified. Follow up information was received from a physician who reported that on 17-SEP-2008 at 10:40 AM, the patient was vaccinated intramuscularly in the left arm with ZOSTAVAX (Merck) (Lot# 659760/0159X). On 28-JUL-2009 the patient developed herpes zoster 10 months after receiving ZOSTAVAX (Merck). At the time of reporting, the outcome of herpes zoster was unknown. The reporting physician considered "ZOSTAVAX failure" as an other important medical event. Follow up information received from medical records on 27-JUL-2009 reported that the patient had varicella in his childhood. Six months ago, in January 2009 (conflicted with previous reported as 17-SEP-2008) the patient had ZOSTAVAX (Merck) vaccinated. 3 weeks ago, on approximately 06-JUL-2009 (conflicted with previous reported as 15-MAY-2009), itchy lesion was noted in the left dorsal thumb and alcohol hydrocortisone (HC) 2.5%, was prescribed and healed popular was seen. Lesion was also noted in the right infraorbital, it was gritty and became pustular. The lesion began 3 weeks ago, on approximately 06-JUL-2009 (conflicted with previous reported onset date as 15-MAY-2009 and 28-JUL-2009), it was persistent, resolved and recurred and at this visit a 2cm plague with punctuate and erupted papular on the right cheek could be seen. About 1 week ago, in approximately 20-JUL-2009 (conflicted with previous reported onset date as 15-MAY-2009 and 28-JUL-2009), the patient had intensely pruritus lesion of left forearm with myalgia. The physician doubted that the persistent lesions which had lasted for 3 weeks were zoster and were triggered by ZOSTAVAX (Merck) which was vaccinated 6 months ago. VALTREX 1g TID for 1 week then 500mg BID for 2 weeks as suppression dose and BACTROBAN ointment, BID for 10 days were prescribed. Viral culture and bacterial culture were performed. The patient would return to clinic in 10 or 14 days. Follow up information received from medical records on 05-AUG-2009 reported that the lesion in the left thumb and left forearm could no longer be seen. A 2cm patch healed from 1 week ago, which was on approximately 29-JUL-2009, could be seen. The reporting physician felt that the doubtful recurrent zoster was less likely to ZOSTAVAX (Merck). Viral swab of right cheek lesion was performed and sent for PCR DNA. VALTREX 1g TID for 1 week had been prescribed and the plaque was resolved, 500mg BID for 2 weeks was continued to use, if lesions recurs, culture would be ordered pre VALTREX. Additional information has been requested. All available medical records will be provided upon request.