A 23-month-old girl presented with an erythematous papular rash on her torso that extended in a linear pattern around to the back. The mother first noticed the rash while bathing the child 3 days earlier. The child had no associated itching, irritability, or fever, but she had mild rhinorrhea preceding the rash that resolved without treatment. The patient and her older sibling were cared for at home by their mother.
The toddler was afebrile and appeared relatively happy. Based on the patient's clinical presentation and history, which included varicella vaccination at 12 months of age, a diagnosis of post-vaccination herpes zoster was made.
According to the CDC, post-vaccination herpes zoster develops in about 18 of 100,000 children. Because varicella is a live vaccine, the virus may lie dormant in the CNS and become activated at any time; however, reactivation is usually secondary to a depressed immune system.
This infant was treated with a 5-day course of acyclovir. The family was cautioned to keep the rash covered because of the slight risk of spreading the virus through contact with open vesicles. *