Varicella Zoster Reactivation Post COVID-19 Vaccination: Two Case Reports

Abstract

Background: After initiation of COVID-19 vaccination, many side effects were described (Itching, swelling, pain, redness, induration, coughing, fatigue, fever, diarrhea, nausea, headache, vomiting, pruritus, myalgias, arthralgias, anorexia, malaise). Whether traditional, vector-based, or mRNA-based, all COVID-19 vaccines have had many mild and severe adverse events. In this article, we describe two cases of Varicella-Zoster Virus (VZV) reactivation one day after receiving Pfizer’s mRNA-based vaccine first dose, and another one month after the second dose. Both patients were not immunodeficient and not on immunomodulator therapy. To our knowledge, few similar cases have been described in the literature before, and thus it would be an important addition to guide future expectations and management in morbid patients receiving the mRNA vaccine for COVID-19.

Case presentation: Case one is a 74-year-old male who presented with zoster reactivation one day after receiving the first mRNA COVID-19 vaccine. He was treated successfully with valacyclovir. The second case is an 83-year-old lady who presented with facial zoster reactivation one month post the second dose of the mentioned vaccine and was also treated with oral valacyclovir.

Conclusion: The patients were not immunodeficient and not on immunomodulatory therapy, which is a major difference from the other reported cases, which are already few in the literature. To our knowledge, very few similar cases have been described in the literature before. Reporting more of such rare side effects would be of utmost importance to establish a full side effect profile of mRNA vaccines and to better understand such clinical finding. It is worth noting, however, that despite the risks that accompany these vaccines, the benefits far outweigh them.