Pediatric Herpes Zoster in a 10-Year-Old Boy With Delayed Immunizations: A Case Report

Abstract

Herpes zoster (HZ), caused by the reactivation of latent varicella-zoster virus, is a condition typically associated with older adults and immunocompromised individuals, though it can also occur in children. Pediatric HZ is rare but can follow a natural varicella infection, particularly in unvaccinated children. We report a case of a 10-year-old immunocompetent boy with a history of natural varicella infection at two years old and a delayed vaccination schedule who developed HZ following a viral illness. He presented with a painful, pruritic vesicular rash in a T4-5 dermatomal distribution, and his symptoms resolved with symptomatic management. This case underscores the critical role of routine varicella vaccination in preventing primary varicella infections and reducing the risk of HZ. While pediatric HZ is often mild, clinicians should remain vigilant for its occurrence and potential complications, particularly in unvaccinated children or those with incomplete immunization histories. Early recognition and management are essential to optimize patient outcomes and mitigate complications.

Keywords: herpes zoster reactivation; herpes zoster virus; pediatric derm; vaccination status; vesicular rash.

Figure 1. Clinical presentation of the patient’s vesicular rash on his chest (A) and back (B) that does not cross the midline.