Article in Japanese

A case of herpes zoster caused by vaccine-strain varicella with motor paresis

Toshiki TAKEO¹⁾, Michio SUZUKI¹⁾, Makoto MORITA¹⁾, Yoshiki KAWAMURA²⁾, Tetsushi YOSHIKAWA²⁾, Shinji HASEGAWA¹⁾

There have been few reports of herpes zoster caused by vaccine-strain varicella in Japan, and even fewer on motor paresis as a complication. This study presents a case of herpes zoster caused by vaccine-strain varicella with motor paresis. A healthy 8-year-old boy presented with weakness and painful skin vesicles on his right upper arm after receiving varicella vaccine in that area at the age of 3 years. Four days later, he was admitted to this hospital. On admission, the vesicles on the right upper arm were in a C5–6 dermatomal distribution, and his right upper extremity muscle strength was reduced to 4 on manual muscle testing. The diagnosis was herpes zoster and treatment with intravenous acyclovir was started. His muscle strength had recovered completely by day 5 and there were no sequelae. The varicella zoster virus (VZV) antibody titer (determined by enzyme immunoassay) was 32.2/128 for IgG and 0.06/0.87 for IgM in paired serum samples. A VZV LAMP assay of vesicular fluid was positive, and restriction fragment length polymorphism analysis of the VZV LAMP products identified a vaccine strain. Given that the varicella vaccine became routine in Japan in 2014, the number of VZV vaccine-related herpes zoster cases is likely to increase. When a patient with a history of VZV vaccination develops herpes zoster, it is important to distinguish whether it originated from a vaccine or a wild-type strain.

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1) Department of Pediatrics, Nagoya Memorial Hospital
2) Department of Pediatrics, Fujita Health University Hospital

Key words	varicella zoster virus, herpes zoster, varicella vaccine, motor paresis, restriction fragment length polymorphism analysis
Received	May 21, 2020
Accepted	August 12, 2020

32 (4)：375─379,2020