Varicella-Zoster Meningitis in an Immunocompetent Male without Fever or Rash

Zoster Sine Herpete: two unusual cases of varicella-zoster reactivation with atypical complaints of acute chest pain and severe headache

In this case report, we describe two unusual presentations of varicella-zoster virus (VZV) reactivation without rash, a condition known as Zoster Sine Herpete (ZSH). In Case 1, a 58-year-old woman presented with severe right-sided chest pain under her breast that radiated to the ipsilateral back. After the initial workup ruled out cardiac and musculoskeletal etiologies, the characteristic dermatomal distribution of pain made us suspect VZV reactivation. A diagnosis of ZSH was made with positive VZV IgG and IgM serologies and symptomatic relief after famciclovir treatment. In Case 2, a 43-year-old woman presented with a severe headache and resolved sharp right flank pain. She was diagnosed with varicella meningitis after cerebrospinal fluid showed positive VZV DNA. Intravenous acyclovir treatment resulted in symptom resolution. The most common presentation of VZV reactivation is Herpes Zoster, or shingles, making ZSH a frequently missed diagnosis. High clinical suspicion is warranted to prevent life-threatening complications of ZSH.

Case Report: Various Clinical Manifestations Caused by Varicella-Zoster Virus in a Family

A family cluster of varicella-zoster virus (VZV) infections was reported. Four family members (two children and their parents) continuously develop varicella after the grandmother's herpes zoster. The unvaccinated 16-month-old infant and his mother developed primary varicella with atypical clinical presentation; however, his 28-year-old father presented with a typical generalized vesicular rash. His vaccinated 4-year-old sister was clinically mild, which could be defined as a breakthrough varicella case. They infected the same virus strain but presented various clinical forms.

Varicella-Zoster Virus Reactivation in AIDS Patient After Pfizer-BioNTech COVID-19 Vaccine

Since early 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of individuals and changed the face of medicine. As the fight against COVID continues, there is still unclear long term effects; although as time passes, more and more is being updated, in regards to the risks of exposure, length of recovery, outcomes of those infected, effectiveness of vaccines, and both expected and unique side effects of both the virus and vaccines, all in an array of individuals. This paper will review a unique topic of the SARS-CoV-2 virus and the abnormal immune response in a young patient. This case is unique due to the fact that there have been an abundance of side effects reported that are associated with the virus that affects every organ system, yet very few have affected the neurological and integumentary (skin) system. This case emphasizes the reactivation of a Herpes/Varicella-Zoster virus (VZV) in a young male shortly after he received the Pfizer-BioNTech COVID-19 vaccine. The other interesting aspect about this case is the patient’s immunocompromised state, as he was diagnosed with HIV several years before this viral reactivation occurred. The interesting aspect about this was trying to understand whether the VZV was truly reactivated because of an overly stressful immune reaction in response to the Pfizer-BioNTech COVID-19 vaccine or was it mainly due to the patient’s already weak immune system, or even a combination of both? The in-depth review will evaluate whether there should be more done in regards to bringing more awareness about potential side effects and preparing for a VZV reactivation and/or other dermatological complications after being vaccinated. This presentation could also simply be a very unique, isolated case, and that each individual should have no hesitations regarding the Pfizer-BioNTech COVID-19 vaccine.