Disseminated vaccine-strain varicella-zoster virus reactivation in an adolescent with secondary immunodeficiency: a case report and literature review.

in BMC infectious diseases by Oluwatomini A Fashina, Tony M Chuang, Paul J Galardy, W Charles Huskins, Emily R Levy, Nicholas T Streck, Rana Chakraborty

TLDR

  • A 16-year-old girl with Hodgkin's lymphoma developed a rash after finishing chemotherapy. She had received vaccines against chickenpox before, but the rash was caused by a strain of the virus that was in the vaccine. The girl was treated with medicine and made a full recovery. This case shows that even though vaccines are effective, there can still be complications if someone's immune system is weakened later on.

Abstract

Routine childhood immunization against varicella-zoster virus has led to a dramatic reduction in the incidence of primary varicella. However, there are rare, yet significant cases reported of reactivated Oka-strain varicella, primarily in immunocompromised hosts. A 16-year-old female with Hodgkin's lymphoma developed a vesicular rash shortly after completing all chemotherapy treatment. Swabs obtained from the vesicles were positive for varicella-zoster virus. By the time of hospitalization, the patient developed a disseminated rash involving multiple dermatomes. Subsequent polymerase chain reaction confirmed Oka vaccine-strain varicella-zoster virus. The patient had previously received a primary series of immunizations against varicella in 2008 and 2012, with her 2nd dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin's lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalization and monitored clinically for cutaneous disease progression as well as sequelae. After 8 days of inpatient treatment, her rash had stopped spreading with no new lesions. All earlier lesions had crusted over. No serious sequelae of disease such as pneumonitis, hepatitis, encephalitis, or meningitis occurred, and she made a complete recovery. There are individual and community-wide benefits to childhood immunization against varicella. This case highlights an unusual presentation of disseminated vaccine-strain herpes zoster in an adolescent with secondary immunodeficiency 11 years after completing primary immunization. In addition, this case informs pediatricians of complications that can arise in immunized subjects if they become immunosuppressed years later. The only way to distinguish between wild-type and vaccine-strain herpes zoster was by viral genotyping. Providers should be cognizant of potential vaccine virus reactivation in their differential. Considerations for work-up and management should include infection control and viral resistance in refractory cases.

Overview

  • The study focuses on the reactivation of Oka-strain varicella-zoster virus in a 16-year-old female with Hodgkin's lymphoma who had previously received a primary series of immunizations against varicella in 2008 and 2012. The study aims to investigate the unusual presentation of disseminated vaccine-strain herpes zoster in an adolescent with secondary immunodeficiency 11 years after completing primary immunization and inform pediatricians of potential complications that can arise in immunized subjects if they become immunosuppressed years later. The study uses a case report to present the patient's experience and highlights the importance of viral genotyping to distinguish between wild-type and vaccine-strain herpes zoster.

Comparative Analysis & Findings

  • The study compares the outcomes observed in the patient with Hodgkin's lymphoma who developed disseminated vaccine-strain herpes zoster with the general population. The patient's presentation was unusual, with a disseminated rash involving multiple dermatomes, which is not common in vaccine-strain herpes zoster. The study found that the patient had previously received a primary series of immunizations against varicella in 2008 and 2012, with her 2nd dose given 11 years prior to her development of vaccine-strain herpes zoster and 10 years prior to her diagnosis of Hodgkin's lymphoma, respectively. The patient was treated with parenteral acyclovir upon hospitalization and made a complete recovery. The study highlights the importance of viral genotyping to distinguish between wild-type and vaccine-strain herpes zoster.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice. The study informs pediatricians of potential complications that can arise in immunized subjects if they become immunosuppressed years later. The study also highlights the importance of viral genotyping to distinguish between wild-type and vaccine-strain herpes zoster. Future research directions could focus on identifying other potential complications that can arise in immunized subjects if they become immunosuppressed years later and developing strategies to prevent or mitigate these complications.
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