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Case Reports
. 2022 May 23;37(20):e165.
doi: 10.3346/jkms.2022.37.e165.

A Case Report of Herpes Zoster Ophthalmicus and Meningitis After COVID-19 Vaccination

In-Cheon You  1 , Min Ahn  2 , Nam-Chun Cho  2
Affiliations
Case Reports

A Case Report of Herpes Zoster Ophthalmicus and Meningitis After COVID-19 Vaccination

In-Cheon You et al. J Korean Med Sci. .

Abstract

There are several reports that herpes zoster characterized by reactivation of varicella zoster virus (VZV) following coronavirus disease 2019 (COVID-19) vaccines can occur. Herein, we report VZV meningitis, herpes zoster ophthalmicus (HZO), and late neurotrophic keratitis after receiving a second dose of messenger RNA (mRNA) COVID-19 vaccine. A 74-year-old man developed a vesicular skin rash on the forehead, scalp, nose, and left upper eyelid with a severe headache. Five days earlier, he received a second dose of the BNT162b2 mRNA vaccine on his left arm. Ocular examination revealed conjunctival hyperemia and pseudodendrite in the peripheral cornea. VZV was detected in the cerebrospinal fluid using polymerase chain reaction. The patient was diagnosed with HZO and meningitis. The patient was treated with intravenous acyclovir and topical acyclovir ointment and levofloxacin 1.5% eye drops. One month later, he developed a central epithelial defect with a rolled margin, typical of a neurotrophic ulcer. Treatment with a therapeutic contact lens and a combination of topical recombinant human epithelial growth factor and ofloxacin ointment was initiated. At six months after vaccination, the slit-lamp examination findings were stable with a mild corneal superficial stromal haze.

Keywords: COVID-19 Vaccination; Herpes Zoster Ophthalmicus; Meningitis; Neurotropic Keratitis.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Photographs of herpes zoster ophthalmicus. Initial photograph showing erythematous grouped vesicle and crust on the left side of the face in 74-year-old man.
The figures are published under agreement of the patient.
Fig. 2
Fig. 2. Anterior segment photography of the patient at first day. Slit-lamp examination revealed multiple pseudodendrite with rarely staining with fluorescein in the peripheral cornea.
Fig. 3
Fig. 3. Anterior segment photography of the patient at one month. Neurotrophic ulcer showing central corneal smooth, oval with heaped-up epithelium at border. The figures are published under agreement of the patient.
See this image and copyright information in PMC

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