Herpes Zoster in an Unvaccinated Child

A painful rash suddenly developed on the chest wall of an otherwise healthy 8-year-old girl. Examination of the rash revealed grouped vesicles with an erythematous base in a linear distribution along the T5 dermatome. The child had not been vaccinated with varicella vaccine and had had chickenpox 3 years earlier. While herpes zoster is not common in children, it can occur. If this patient had received the varicellazoster virus vaccine, she may have avoided both chickenpox and herpes zoster. Unfortunately, some scarring will likely develop given the extent of her blistering. However, at her age, she should not experience significant post-herpetic neuralgia. Transmission of varicella to a susceptible person is possible, but herpes zoster itself is not contagious. This patient was treated with valacyclovir, 500 mg tid for a week, and prednisone, 20 mg/d for the first week and 10 mg/d for the second week.