Sex: M
Vaccine: MMRV, VARCEL, VARZOS
Symptoms: Arthralgia, Herpes zoster, Pyrexia, Rash, Ultrasound scan normal
Clinical narrative: This literature report has been received from the authors of a published article. In this case series, the authors described seven immunized healthy children without a history of primary varicella who presented with herpes zoster that correlated with the vaccination site of live attenuated varicella-zoster vaccine. These cases highlight the varied clinical presentations and diagnostic and therapeutic considerations for herpes zoster in healthy children. Seven vaccinated healthy children without underlying immunodeficiency presented with herpes zoster in the limb that correlated with the vaccination site. Their clinical histories are summarized. Each patient underwent varicella zoster vaccination at 12 to 14 months of age. The pediatrician's office confirmed the site of vaccination in six patients and the parents in the seventh. Median age at presentation was 3 years (range 1.5-6 years). There were no precipitating factors elicited by history in five patients; one patient developed the rash at the site of recent influenza vaccination and one patient developed the rash after surgery. The morphology of the lesions included erythematous papules, pseudovesicles, pustules, and plaques, with associated pain in two patients and pruritus in three. Systemic symptoms ranged from none to low-grade fevers, upper respiratory symptoms, and joint pain. Clinical and laboratory findings, specifically positive direct fluorescent antibody (DFA) testing, were consistent with herpes zoster in four cases; because of distinct similarities in the clinical examination, DFA testing was not conducted in the other three cases. Acyclovir was prescribed for five patients but deferred in two because of the mild or late presentation. The evaluating physician's differential diagnosis in the seven cases included viral exanthem, eczema herpeticum, atopic dermatitis, contact dermatitis, microcystic lymphatic malformation, herpes simplex infection, and herpes zoster infection. In one patient with knee pain, there was initial concern for septic hip, but inflammatory markers were not elevated, joint effusion was not seen on ultrasound, and the rash and knee pain self-resolved after several days. This report refers to a 3 year old male patient without a history of primary varicella. On an unknown date, the patient was vaccinated with varicella-zoster vaccine (code as "varicella virus vaccine live (Oka/Merck) (manufacturer unknown), Zoster Vaccine Live (manufacturer unknown) and Measles, Mumps, Rubella and Varicella (Oka-Merck) Virus Vaccine Live (manufacturer unknown)") (dose and route unknown, left thigh) for prophylaxis. On an unknown date (reported as 33 months later), the patient experienced herpes zoster in left leg (in L4 dermatomal distribution) with symptoms of fever and joint pain. The reporter stated that there was initial concern for septic hip, but inflammatory markers were not elevated, joint effusion was not seen on ultrasound, and the rash and knee pain self-resolved after several days. The patient did not have direct fluorescent antibody (DFA) test. The patient did not receive acyclovir treatment for the event. The outcome of the event was recovered without complications. The reporter considered the event of herpes zoster was related to the suspected therapies. This is one of several reports from the same reporter.; Sender's Comments:  US-009507513-1802USA003640: