Age: 74.0
Sex: M
Vaccine: VARZOS
Symptoms: Rash, Restlessness, Skin lesion, Tremor, Varicella virus test positive
Clinical narrative: skin rash extending from the left sacral region to the left inner thigh and down to his left ankle; increased lethargy with disorientation and confusion; mild cognitive deficits decreased strength; mild tremors, shakiness; Encephalitis; Encephalomyelitis; Mild cerebral atrophy; aphasia; VZV meningoencephalitis/Acute decrease in function due to VZV encephalomeningitis/CSF  and  VZV encephalomeningitis; atypical measles syndrome; altered mental status; shingles lesions worsened/developed skin lesions on left leg; Nerve pain/Peripheral neuropathic pain; lower extremity weakness /severe left lower extremity pain; This case was reported by a lawyer and described the occurrence of herpes zoster meningoencephalitis in a male patient who received Herpes zoster (Shingrix) (batch number UNK, expiry date unknown) for shingles.  The initial information was received on 29 July 2020 via medical records (case now medically confirmed). As per pharmacy record, the patient had first dose of vaccine on 29 August 2019 and second dose of vaccine 02 November 2019. The patient was admitted from 14 November 2019 to 30 November 2019. The patient had shingles admitted to hospital on 14 November 2019 with atypical measles syndrome and complaints of altered mental status. The patient had shingles vaccine 02 November 2019 , developed severe left lower extremity pain. On 08 November 2019 and was told it was nerve pain. On 12 November 2019, the patient developed skin lesions on left leg and was started on antiviral Valtrex. On 13 November 2019 the patient was extremely restless , shingles lesions worsened. The patient was found to have a skin rash extending from the left sacral region to the left inner thigh and down to his left ankle. He had low-grade fever, lower extremity weakness causing frequent falls and increased lethargy with disorientation and confusion. At the time of admission the patient was unable to follow commands and disoriented. The patient was admitted for encephalitis and acute decrease in function due to VZV encephalomeningitis. After getting shingles vaccine, patient had CSF plus VZV encephalomeningitis. The patient had left lower extremity associated with neuropathic pain, increased falls, generalized weakness, disorientation and altered mental status several days after getting his second shingles vaccination. The patient was intubated and ventilated from 18 November 2019 to 21 November 2019 and , treated for presumed zoster meningoencaphilitis with IV acyclovir, and IV solumedrol. IV solumedrol tapered to off on 24 November 2019. The patient had VZV meningoencephalitis with significant LLE weakness and mild cognitive deficits decreased strength, endurance, balance, coordination, cognition, with impaired mobility and increased lethargy and confusion, Significant focal deficits, mild tremors, shakiness and Altered mental status, neuropathic pain.The patient had diagnosis was zoster meningitis, zoster rash,encephalitis , aphasia encephalomyelitis. The patient CSF was positive for varicella zoster virus, VZV encephalitis Positive varicella zoster virus with lymphocytosis and elevated CSF protein. CT of brain showed mild microvascular chronic ischemic changes and Mild cerebral atrophy .