SHM Converge Scientific Abstract ePoster Gallery-Facial Dermatomal Rash - A Case of Shingles in a Vaccinated Young Child

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This case report describes a rare instance of herpes zoster ophthalmicus (HZO), or shingles affecting the ophthalmic division of the trigeminal nerve, in a healthy 3-year-old boy who had previously received varicella vaccination. The child presented with 5 days of a scaly, crusting rash that began on the left forehead and progressed to include papules and left eyelid swelling in a V1 dermatomal distribution. He had no history of chickenpox, no known immunodeficiency, and was otherwise healthy.<br /><br />Evaluation by dermatology and ophthalmology confirmed HZO. Laboratory studies were normal, and fluorescein examination with a Woods lamp showed no ocular vesicular lesions. The patient was treated with intravenous acyclovir for 2 days, then transitioned to oral acyclovir to complete a 7-day course. He was also referred for outpatient immunology evaluation because HZO is unusual in an immunocompetent child.<br /><br />The discussion emphasizes that HZO is very rare in children, with only sparse case reports in the literature. Herpes zoster in healthy children occurs at very low rates, and ocular involvement is even less common. When herpes zoster occurs after varicella vaccination, it typically appears within months to a few years and may result from reactivation of either vaccine-strain or wild-type virus. Available data suggest that varicella vaccination lowers overall herpes zoster risk, though wild-type cases remain more common than vaccine-strain cases.<br /><br />The authors conclude that this case adds to the limited literature on pediatric HZO and highlights the need to better understand why some otherwise healthy children develop reactivation. While most pediatric HZO cases have favorable outcomes, rare complications such as ocular disease, uveitis, and stroke have been reported.

Asset Subtitle

Vrunda Vithalani

Meta Tag

Author List Emily Gibbons, Jennifer Jordan, Samantha Horn, Sheila Nguyen, Vrunda Vithalani

Category Clinical Vignettes

Concept Herpes Zoster Ophthalmicus

Concept Pediatric Herpes Zoster

Concept V1 Dermatomal Rash

Concept Ophthalmology Consultation

Concept Acyclovir

Distinguished Non-Finalist

Presenter Organization Penn State Hershey Medical Center

Presenting Author Vrunda Vithalani

Track Pediatric

Keywords

herpes zoster ophthalmicus

pediatric shingles

varicella vaccination

trigeminal nerve

V1 dermatomal rash

acyclovir treatment

immunocompetent child

ophthalmology evaluation

vaccine-strain reactivation

ocular complications

Herpes Zoster Ophthalmicus

Pediatric Herpes Zoster

V1 Dermatomal Rash

Ophthalmology Consultation

Acyclovir