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Título

OPHTHALMIC HERPES-ZOSTER AFTER VACCINATION AGAINST COVID19: CASE REPORT

RESUMO

CASE PRESENTATION
The patient: Female, 59 years old. No noteworthy medical history, including denying Varicella infection during childhood. On 04/13/2021, she received the first dose of the vaccine against COVID-19 (Coronavac) without post-vaccination reactions. On 05/07/2021, she received the second dose of the Coronavac vaccine, with no adverse reactions until 05/14/2021, when she noticed the appearance of vesicobullous lesions with an erythematous base associated with ocular edema, electric shock-like pain and local hyperesthesia, evidenced in the course of the V1 branch of the trigeminal nerve, being clinically diagnosed as ophthalmic herpes-zoster. Treatment with Acyclovir was started, but hyperesthesia persisted.
DISCUSSION
Trigeminal neuralgia is characterized by paroxysms of excruciating pain in the V nerve. Among the infectious causes, herpes zoster (HZ) should be considered. After primary infection with Varicella, the virus becomes quiescent in cranial sensory nerve ganglia and spinal dorsal. Regarding vaccination against COVID-19 until the present writing of this article, case reports were observed in Europe. No case reports were found on the South American continent. A systematic review entitled ‘‘Can SARS-CoV-2 vaccine increase the risk of reactivation of Varicella zoster?’’ showed a relationship between HZ development and mRNA vaccination against COVID-19. A total of 54 cases were analyzed. The median period between the development of HZ and vaccination against COVID-19 was 7 days. 68.27% of HZ cases were reported by mRNA vaccine. Thirty-six patients 36/45 developed HZ after the initial dose of COVID-19 vaccine among those who received the mRNA vaccine. This led to the hypothesis that the disease, with physical stress, could trigger HZ. Functional impairment of T lymphocytes could reactivate varicella zoster virus. Another study titled “Phase I/II study of COVID-19 RNA vaccine BNT162b1 in adults” on Nature, showed a transient decrease in lymphocyte counts observed within a few days after vaccination and return to baseline within 6-8 days on all participants. Thus, associating this post-vaccination lymphocytopenia and the Varicella virus reactivation, precisely when there is a drop in CD4+ and CD8+ levels to be a plausible justification.
FINAL CONSIDERATIONS
The report a case in which HZ 7 developed days after vaccination against COVID-19 in a patient without comorbidities. Consider the report of importance to the scientific community.

Palavras Chave

Herpes-zoster; COVID-19; Coronavac; post-vaccination; SARS-CoV-2; trigeminal; neuralgia; lymphocytopenia; Varicella;