Abstract
Herpes zoster ophthalmicus (HZO), which is an ophthalmological emergency, accounts for 10%-20% of all Herpes zoster (HZ) cases. HZ infection in COVID-19 vaccinated individuals who are immunocompetent can be attributed to vaccine-induced immunomodulation allowing the varicella-zoster virus (VZV) to escape from the dorsal root ganglia. Another theory is similar to immune reconstitution syndrome (IRS). HZ infection in a young immunocompetent individual is a rare entity. As per our literature review, only four cases have been reported thus far. We are reporting two cases of two young individuals with no known risk factors who developed ipsilateral HZO after receiving the COVID-19 vaccination. The increasing incidence of HZ cases post COVID-19 vaccine indicates that this is not a mere coincidence. Awareness must be created among physicians, as well as the general population, for early recognition and early antiviral usage, which can halt the progression of the disease and thus prevent debilitating complications.
Highlights
Reactivation of varicella-zoster virus (VZV) in the ophthalmic division of trigeminal nerve manifests as an ophthalmologic emergency termed herpes zoster ophthalmicus (HZO)
We report two cases of HZO in healthy, middle-aged men without any physical or emotional stressors approximately one week after receiving a COVID-19 vaccine
VZV reactivation occurs when there is downregulation of major histocompatibility complex class 1 resulting in inhibition of interferon response which acts as an antiviral, triggering the viral replication [1]
Summary
Reactivation of varicella-zoster virus (VZV) in the ophthalmic division of trigeminal nerve manifests as an ophthalmologic emergency termed herpes zoster ophthalmicus (HZO). A 42-year-old male with a past medical history of asthma presented to the emergency room with complaints of worsening painful lesions on the left side of his forehead and blurred vision. He stated that he received Johnson and Johnson COVID-19 vaccine on his left arm recently, after which he experienced generalized weakness for two days. A 49-year-old male with a past medical history of bipolar disorder, schizophrenia, and hyperlipidemia presented to the emergency room with worsening burning pain on the right side of the forehead and blurred vision. He was started on systemic antiviral therapy with an improvement of his symptoms
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