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Herpes zoster in an immunocompetent infant with a history of varicella in early infancy and after a minor injury - case report and literature review

Introduction. Chickenpox is a common pediatric disease,
 while herpes zoster (HZ) is rare among children, especially among infants.
 HZ in infancy may appear after intrauterine or postnatal infection with
 varicella-zoster virus (VZV). We report on a case of HZ in an
 immunocompetent infant who had a history of chickenpox in early infancy. 
 Case outline. A seven-month-old male infant was presented with skin changes
 in the left T1 and T2 dermatomes. Skin changes appeared eight days after the
 infant had a mild left-arm traction injury. The patient?s medical history
 revealed that he had a mild form of chickenpox at the age of three and a
 half months. After the clinical diagnosis of HZ was made, he was treated
 with oral acyclovir 20 mg/kg every six hours for five days and had complete
 recovery without any sequelae. Conclusion. Risk factors for pediatric HZ
 are immunosuppression and chickenpox during the first year of life. Local
 trauma is a reported risk for VZV reactivation among adults. To our best
 knowledge, our case is the first reported pediatric case in which the injury
 of the left arm precedes HZ appearance. Routine vaccination against
 chickenpox may be an important preventive measure because herd immunity will
 protect infants and immunocompromised children from getting chickenpox and
 thus HZ.