Herpes Zoster as first manifestation of varicella-zoster virus infection in a healthy child

Abstract

Herpes zoster (HZ) results from reactivation of varicella-zoster virus. HZ’s incidence increases with age and although rarely, it can affect healthy children. We describe a previously healthy 29-months-old girl with herpes zoster ophtalmicus. She presented with fever and a painful vesicular skin rash covering the right forehead. She had no past history of clinical varicella or varicella vaccination, although she had household contact with varicella at two months-old. Serologic varicella zoster virus tests were initially negative, but seroconversion occurred 8 weeks later. Polymerase chain reaction assay of the vesicles fluid was positive for the virus. Intravenous acyclovir was started and the patient recovered without sequelae. HZ may occur in an otherwise healthy young child without previous noticed varicella and with negative acute phase serology. This can be explained by the immaturity of the immune system associated with transplacental transfer of maternal antibodies affecting immunologic response to early primary infection.