Sex: M
Vaccine: COVID19, VARCEL
Symptoms: Vaccination failure, Varicella meningitis, Varicella post vaccine
Clinical narrative: zoster meningitis reactivation from live-attenuated varicella vaccine (vOka); zoster meningitis reactivation from live-attenuated varicella vaccine (vOka); zoster meningitis reactivation from live-attenuated varicella vaccine (vOka);   This literature marketed report has been received from authors of a literature article and refers to a 12-year-old male, healthy patient. No information regarding the patient's concomitant therapies and medical history was provided. On an unknown date, the patient was vaccinated with varicella virus vaccine live (oka/merck) (manufacturer unknown) (strength, dose, frequency, route of administration, lot# and expiration date were not reported) for prophylaxis and with bnt162b2 (strength, dose, frequency, route of administration, indication, lot# and expiration date were not reported). On an unknown date, he was evaluated in a hospital for papulovesicular rash with lumbar L1 dermatomal distribution; the rash gradually progressed to the L2 area, trunk, and scalp. The rash was preceded by a 1-week history of severe flank and thigh pain. The patient initially was seen at another hospital, where abdominal/pelvic computed tomography imaging led to a diagnosis of kidney stones and mesenteric adenitis. His pain persisted after discharge, and he then developed the vesicular rash described, along with twitching movements, headache, and photophobia. No change in mentation or focal neurologic findings were noted. The patient was otherwise healthy and taking no medications, including inhaled corticosteroids. His immunizations were up-to-date, including 2 doses of vOka, 1 at age 12 months and another at 18 months. He received his first dose of BNT162b2 vaccine 11 days before onset of the symptoms described. Laboratory studies revealed levels of leukocytes, platelets, C-reactive protein and transaminases within reference ranges. The cerebrospinal fluid had a leukocyte level of 252 cells/mm3 (reference range 05 cells/mm3) and a protein level of 96 mg/dL (reference range 1545 mg/dL). Results of gram stain and cultures were negative. Cerebrospinal fluid and vesicular lesions were PCR-positive for varicella zoster virus (VZV) (zoster meningitis reactivation from live-attenuated varicella vaccine (vOka)) and were determined to be the vOka strain by the Centers for Disease Control and Prevention using a VZV fluorescence resonance energy transfer PCR. A cerebrospinal fluid viral meningoencephalitis antibody panel with more than 30 targets detected only VZV antibodies. The ePlex respiratory pathogen panel PCR was positive for only rhinovirus/enterovirus, presumably representing recent infection. Other studies, including those for human immunodeficiency virus (HIV), herpes simplex virus, SARS-CoV-2, and QuantiFERON-TB, were negative. Immunologic (T-cell, B cell, and natural killer cell cytotoxicity) studies revealed no underlying immunodeficiency. Exome sequencing performed using the Agilent SureSelect Clinical Research Exome XT kit. The patient was treated with intravenous acyclovir for 10 days and recovered uneventfully. The authors considered the events of zoster meningitis reactivation from live-attenuated varicella vaccine (vOka) (Varicella meningitis, Varicella post vaccine and Vaccination failure) to be related to suspect vaccines  Upon internal review, the event of zoster meningitis reactivation from live-attenuated varicella vaccine (vOka) (Varicella meningitis) was considered to be medically significant.