To the Editors: Herpes zoster tends to be recognized as a regional manifestation of varicella-zoster virus (VZV) reactivation, but it might be accompanied by complications in the central nervous system, such as cranial nerve palsies, meningoencephalitis or myelitis. Meningitis in the course of VZV reactivation in immunocompetent children is very rare, showing an incidence of 5.4% in children with zoster.1 VZV travels also to the arterial adventitia, and thus, it may lead to vascular complications. Zoster ophthalmicus in particular can lead to the involvement of the cerebral arteries and subsequent stroke.2 A 12-year-old boy presented to the emergency room with suspicion of herpes zoster ophthalmicus. Six days before admission, the patient developed a fever >39 °C, a left-sided headache, followed by 2 episodes of vomiting. Three days before the admission, the patient’s mother noticed vesicular lesions on the left upper eyelid and eyebrow (Fig. 1). The boy had no history of head trauma nor any gait/balance disturbances. He had been diagnosed with varicella at the age of 2 weeks (direct contact with a sibling suffering from chickenpox). The patient reported no chronic diseases, no recurrent infections or loss of weight. The patient had been consulted in the Pediatric emergency room 1 day before the admission and had been referred to an ophthalmologist. On the day of admission, the ophthalmologist diagnosed him with herpes zoster ophthalmicus, but no further investigations were undertaken. On admission to our department, the patient was under a fair general condition, GCS 15, with normal vital signs, with an adequate psychological condition. Vesicular lesions on an erythematous basis without signs of bacterial superinfection were found on the left upper eyelid, the left eyebrow, and the left frontotemporal region. Some of the lesions were in the stage of crusts. His head was tender on palpation in the regions of C2-C3 dermatomes. Submandibular lymph nodes were enlarged to 1.5 cm. Meningeal and cerebellar signs were negative. No nuchal rigidity was observed. No other abnormalities were found on physical examination. Blood analysis showed no abnormalities except for slight domination of lymphocytes in the peripheral blood smear. Inflammatory markers were low. Cerebrospinal fluid (CSF) analysis revealed pleocytosis of 223 (94% lymphocytes), with normal protein and glucose levels. Multiplex PCR testing of CSF detected DNA of VZV. Diagnosis of zoster meningitis was established. Intravenous acyclovir in the dosage of 500 mg/m2 every 8 hours was implemented for 10 days. The patient was discharged home in good general condition with no neurologic complications.FIGURE 1.: Herpes zoster ophthalmicus lesions before admission to the hospital.In the study by Petursson et al, patients were followed for up to 6 years and no association between the risk of undiagnosed malignancy and shingles in childhood was found. We want to highlight that collecting thorough history of a patient is sufficient for selecting patients at the risk of neoplasms or immune deficiencies and broad laboratory testing, imaging studies or invasive investigations are not indicated in children with zoster.3 This article draws attention to the early recognition of zoster and even more its complications in immunocompetent children.