Gopi Ranitha, Stanley Weena, Surkunda Shashikala Taggarshe, Rajagopal Sriraam
Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104.
Heliyon. 2024 May 31;10(11):e32248. doi: 10.1016/j.heliyon.2024.e32248. eCollection 2024 Jun 15.
A middle-aged gentleman, presented to our outpatient department with painful skin lesions suggestive of disseminated herpes zoster. Further examination revealed bilateral cerebellar signs. He had a history of receiving a third dose of AZD1222 vaccine fourteen days prior to the onset of skin lesions but had no other significant medical history. The patient was also evaluated for retroviral infection and other immunodeficient states, workup for which were negative. The patient was initially treated with intravenous acyclovir 7.5 mg/kg/q8H; however, the patient developed varicella encephalitis on treatment, which was followed by pneumonia and haemorrhagic cystitis. Subsequently, treatment was started with acyclovir 10 mg/kg/q8H for 14 days, followed by valacyclovir for eight days, following which there was near-complete resolution of symptoms with the persistence of minimal rigidity. Although there have been several reports of herpes zoster following SARS-CoV-2 vaccination, we found few reports of varicella zoster with systemic manifestations following ChAdOx1 nCoV-19 (AZD1222) vaccination. This case highlights the importance of considering varicella zoster reactivation in a patient presenting with encephalitis or pneumonia post SARS-CoV-2 vaccination.
一位中年男性到我们门诊就诊，其皮肤病变疼痛，提示为播散性带状疱疹。进一步检查发现双侧小脑体征。他在皮肤病变出现前14天有接种第三剂AZD1222疫苗的病史，但无其他重要病史。该患者还接受了逆转录病毒感染和其他免疫缺陷状态的评估，相关检查结果均为阴性。患者最初接受静脉注射阿昔洛韦治疗，剂量为7.5mg/kg/每8小时一次；然而，患者在治疗过程中发生了水痘脑炎，随后出现肺炎和出血性膀胱炎。随后，开始使用阿昔洛韦10mg/kg/每8小时一次治疗14天，之后使用伐昔洛韦治疗8天，此后症状几乎完全缓解，仅遗留轻微强直。虽然有几篇关于接种SARS-CoV-2疫苗后发生带状疱疹的报道，但我们发现接种ChAdOx1 nCoV-19（AZD1222）疫苗后出现伴有全身表现的水痘带状疱疹的报道很少。该病例强调了在接种SARS-CoV-2疫苗后出现脑炎或肺炎的患者中考虑水痘带状疱疹再激活的重要性。
