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Year : 2020  |  Volume : 21  |  Issue : 4  |  Page : 347-348

Herpes zoster in a 3-month-old infant

Department of Dermatology, Venereology and Leprology, RNT Medical College, Udaipur, Rajasthan, India

Date of Submission17-Feb-2019
Date of Decision20-Mar-2019
Date of Acceptance26-Apr-2020
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Lalit Kumar Gupta
Department of Dermatology Venereology and Leprology, RNT Medical College, Udaipur - 313 001, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpd.IJPD_20_19

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How to cite this article:
Makhija R, Gupta LK, Khare AK, Mittal A. Herpes zoster in a 3-month-old infant. Indian J Paediatr Dermatol 2020;21:347-8

How to cite this URL:
Makhija R, Gupta LK, Khare AK, Mittal A. Herpes zoster in a 3-month-old infant. Indian J Paediatr Dermatol [serial online] 2020 [cited 2021 Jan 25];21:347-8. Available from: https://www.ijpd.in/text.asp?2020/21/4/347/296853


Varicella-zoster virus (VZV) causes both varicella (chickenpox) and herpes zoster (shingles); varicella being primary infection usually manifesting during childhood, whereas herpes zoster occurs due to reactivation of the latent virus in adults and elderly.[1] Herpes zoster is uncommon in childhood and very rare in infancy. In infants, herpes zoster is described following intrauterine exposure to VZV.[2] We herein report a 3-month-old infant with herpes zoster, a usual entity with an unusual age of presentation.

A 3-month-old male infant presented with sudden onset skin of eruptions over the left side of the face and neck for 6 days. Cutaneous examination revealed multiple, discrete as well as grouped papulovesicular lesions over the left side of the face and neck along C2, C3, and V3 dermatomes [Figure 1]. There was no history of varicella in the infant. His mother suffered from varicella infection during the 30th week of gestation. The general health of the child was unaffected. Developmental milestones were normal for age.
Figure 1: Papulovesicular lesions of herpes zoster with crusting over left side of face and neck along C2, C3, and V3 dermatomes

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There was no clinical evidence of immunosuppression and enzyme-linked immunosorbent assay for human immunodeficiency virus 1 and 2 was nonreactive in infant and parents. Tzanck smear from lesion revealed multinucleated giant cells [Figure 2]. Lesions healed completely within a week with the fusidic acid cream application.
Figure 2: Tzanck smear showing typical multinucleated giant cell and few acantholytic cells Giemsa, ×1000

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Herpes zoster in infancy or early childhood results from reactivation of VZV infection acquired either in utero or during early infancy.[3] Infants under 6 months of age are usually protected from varicella by maternal immunoglobulin against the virus, thus making infantile herpes zoster a rare occurrence.[4] Maternal varicella during pregnancy and varicella during the 1st year of life represent risk factors for developing herpes zoster during childhood.[5] The majority of cases of childhood zoster occur after the age of 5 years.[6]

Dobrev [7] observed that maternal varicella during the first trimester is likely to produce congenital varicella syndrome; when women have the disease later in pregnancy, the fetus can develop asymptomatic congenital infection and subsequently present clinically with herpes zoster within the 1st year of life. Childhood herpes zoster generally runs a benign and favorable course compared to adults.[8],[9] This seems likely in our case also.

Most of the previously reported cases either had a history of maternal varicella infection [6],[10],[11],[12] or history of exposure to a case of varicella.[4] Only a few cases had no such history, and exposure in these cases was presumed to occur in utero following subclinical maternal varicella infection.[13],[14] None of the cases, including ours, had any evidence of immunosuppression. All the cases had uneventful resolution without any sequelae, as seen in our case.

It is likely that the vesicular lesions of herpes zoster in this age group are misdiagnosed as impetigo or other cutaneous disorders. With a high degree of suspicion, the dermatomal distribution of a vesicular eruption in infancy should point the clinician toward a correct diagnosis of herpes zoster. We report this case due to the rare occurrence of herpes zoster in infancy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Katakam BK, Kiran G, Kumar U. A prospective study of herpes zoster in children. Indian J Dermatol 2016;61:534-9.  Back to cited text no. 1
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Kurlan JG, Connelly BL, Lucky AW. Herpes zoster in the first year of life following postnatal exposure to varicella-zoster virus: Four case reports and a review of infantile herpes zoster. Arch Dermatol 2004;140:1268-72.  Back to cited text no. 2
Laude TA, Rajkumar S. Herpes zoster in a 4-month-old infant. Arch Dermatol 1980;116:160.  Back to cited text no. 3
Kashima M. A rather rare encounter with herpes zoster in a male infant. J Dermatol 2003;30:348-9.  Back to cited text no. 4
Nikkels AF, Nikkels-Tassoudji N, Piérard GE. Revisiting childhood herpes zoster. Pediatr Dermatol 2004;21:18-23.  Back to cited text no. 5
Gupta LK, Khare AK, Mittal A, Kuldeep CM. Herpes zoster in infancy. Indian Dermatol Online J 2013;4:252-4.  Back to cited text no. 6
[PUBMED]  [Full text]  
Dobrev H. Herpes zoster in infants. Folia Med (Plovdiv) 1994;36:45-9.  Back to cited text no. 7
Guess HA, Broughton DD, Melton LJ 3rd, Kurland LT. Epidemiology of herpes zoster in children and adolescents: A population-based study. Pediatrics 1985;76:512-7.  Back to cited text no. 8
Smith CG, Glaser DA. Herpes zoster in childhood: Case report and review of the literature. Pediatr Dermatol 1996;13:226-9.  Back to cited text no. 9
Jha A, Kumar A, Paudel U, Neupane S, Pokhrel DB, Badal KP. Herpes zoster in a five month old infant subsequent to intrauterine exposure to varicella infection. Nepal Med Coll J 2007;9:281-3.  Back to cited text no. 10
Handa S. Herpes zoster in a 3-month-old infant. Pediatr Dermatol 1997;14:333.  Back to cited text no. 11
Bharija SC, Kanwar AJ, Singh G. Ophthalmic zoster in infancy. A case report. Indian J Dermatol 1983;28:173-4.  Back to cited text no. 12
Jain A, Singal A, Baruah MC. Herpes zoster in a 9-month-old infant. Indian J Dermatol Venereol Leprol 1999;65:294-5.  Back to cited text no. 13
[PUBMED]  [Full text]  
Bhushan P, Sardana K, Mahajan S. Dermatomal vesicular eruption in an asymptomatic infant. Dermatol Online J 2005;11:26.  Back to cited text no. 14


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