P08 Shingles in two children with no history of chicken pox

Abstract

Abstract We present two cases of dermatomal, vesicular eruptions in young children. Both were otherwise well with no history of immunocompromise or prior chickenpox (varicella). Child A was 3 years old and presented with painful erythema and pustules to the left side of his nose and cheek with a sharp midline demarcation. He was admitted by the paediatricians, unwell and treated with antibiotics and acyclovir for presumed impetigo or herpes simplex virus infection. However, the swab was positive for varicella zoster virus (VZV), which in this dermatomal distribution is in keeping with shingles. Child B was an 18-month-old girl who was referred with a dermatomal vesico-pustular eruption on the left forehead, scalp and nose unresponsive to antibiotics. Despite the lack of varicella history, shingles was suspected, and the child was started on aciclovir. Swabs were positive for VZV. Shingles is rare in children and usually associated with immunocompromise. It is especially rare in those with no prior history of chicken pox and of the cases in the literature, almost all have had previous vaccination to chicken pox resulting in latent infection and subsequent shingles. We surmise that our otherwise well patients, with no prior vaccination, had previous asymptomatic chicken pox. There was a delay in the diagnosis of patient A who went on to develop trigeminal trophic syndrome with recurrent paranasal ulceration over 18 months. We highlight these cases to make clinicians aware of the possibility of shingles even in very young, immunocompetent children with no prior history of chickenpox.