Abstract
Varicella-zoster virus (VZV; human herpesvirus 3) is a herpesvirus that causes infection in humans. The reactivation of latent VZV manifests as herpes zoster or shingles. In immunocompetent children, reactivation is rare, as increasing age is the most common risk factor for reactivation. The complications of infection include post-herpetic neuralgia and neurological sequelae as well as a bacterial infection of the crusted skin. We present a case of an otherwise healthy 13-year-old child with herpes zoster and multiple risk factors, who was managed successfully, in order to expand the limited literature. The patient presented with a painful vesicular rash, which appeared as multiple grouped vesicles on an erythematous base spreading over the right half of the face. The diagnosis of herpetic (varicella) vesiculobullous dermatitis was confirmed by biopsy and the patient was started on acyclovir and clindamycin with gradual improvement and resolution of his symptoms. Reactivation of VZV is considered a consequence of decreased cell-mediated immunity. However, the reason for reactivation in immunocompetent children remains unclear. In the present case, the patient may have become exposed in utero, through vaccination, or as a result of major facial trauma sustained at the age of six years.
Highlights
Varicella-zoster virus (VZV; human herpesvirus 3) is a human herpesvirus infection that manifests in two clinically distinct forms: primary varicella and herpes zoster
We present a case of a 13-year-old child, who was otherwise healthy, with herpes zoster with multiple risk factors, including intrauterine exposure to VZV infection
Reactivation of VZV infection in immunocompetent children is rare; fewer than 10% of zoster patients are younger than 20 years and only 5% are younger than 15 years [4]
Summary
Varicella-zoster virus (VZV; human herpesvirus 3) is a human herpesvirus infection that manifests in two clinically distinct forms: primary varicella and herpes zoster. Herpes zoster is described as a multivesicular eruptive rash that follows a single or multiple adjacent dermatomal distribution. It is often accompanied or preceded by acute pain and itchiness. We present a case of a 13-year-old child, who was otherwise healthy, with herpes zoster with multiple risk factors, including intrauterine exposure to VZV infection. The lesions were painless, crusted, and peeling, with raw skin underneath, and no limitations of eye or mouth movement were observed He was discharged on 800 mg acyclovir five times per day for seven days as well as topical potassium permanganate and Fucidin cream twice daily for one week.
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