Reactivation of Herpes Zoster Keratitis in an Adult After Varicella Zoster Vaccination. - GreenMedInfo Summary
Reactivation of Herpes Zoster Keratitis in an Adult After Varicella Zoster Vaccination.
Cornea. 2012 Nov 26. Epub 2012 Nov 26. PMID: 23187165
Department of Ophthalmology, University of Florida, Gainesville, FL. The current affiliation for Dr. Saucedo-Sanchez is the California Eye Professionals Medical Group, Menifee, CA.
PURPOSE:: In this study, the case of a patient who presented with reactivation of herpes zoster (HZ) keratitis and worsening of neurotrophic keratopathy, keratouveitis, and keratoconjunctivitis sicca after vaccination with live attenuated HZ vaccine (Zostavax) is described. METHOD:: This is a retrospective case review. RESULTS:: A 63-year-old man, with a history of HZ keratouveitis and neurotrophic keratopathy that had been quiescent for 3.5 years off medication, presented with keratouveitis 2 weeks after Zostavax administration. Oral acyclovir and topical prednisolone acetate and cyclopentolate were started, with subsequent improvement in inflammation and visual acuity. However, the patient was unable to be tapered completely off the steroids. CONCLUSIONS:: HZ keratouveitis is the result of cell-mediated immunity (CMI) directed toward viral antigens within the eye. The live attenuated HZ vaccine, Zostavax, boosts the recipient's CMI to prevent reactivation of HZ. However, patients with a history of HZ keratitis may have persistent viral antigens in their corneas and can develop recurrence of keratouveitis because of the vaccine-induced increase in CMI. Vaccination should be undertaken with caution in patients with a history of HZ ophthalmicus.