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Herpes zoster in the medically healthy child and covert severe child abuse
Insights
Childhood herpes zoster (shingles) in healthy children may signal severe, chronic child abuse. Psychological stress from abuse can suppress immunity, leading to shingles. Clinicians should consider abuse in such cases.
Area of Science:
- Pediatrics
- Immunology
- Psychology
Background:
- Herpes zoster (shingles) is rare in healthy, immunocompromised children.
- It is typically associated with weakened cell-mediated immunity.
Observation:
- Four cases of childhood-onset herpes zoster without underlying medical conditions are presented.
- All patients reported severe, chronic child abuse preceding the onset of shingles.
Findings:
- Severe psychological stress from chronic child abuse may impair cell-mediated immunity.
- This immune suppression could predispose children to developing herpes zoster.
Implications:
- Heightened clinical suspicion for covert child abuse is recommended in healthy children with herpes zoster.
- Considering psychological stress as a factor in pediatric herpes zoster is crucial for diagnosis and management.
Abstract:
Herpes zoster is associated with depressed cell-mediated immunity and occurs rarely in the medically healthy nonimmunocompromised child. We report 4 cases of childhood-onset herpes zoster in the absence of a medical disorder. All 4 patients reported experiencing severe, chronic child abuse when the herpes zoster first appeared. It is possible that the severe chronic psychologic stress resulting from the abuse depressed the patients' cell-mediated immune status and thereby predisposed them to herpes zoster. Our findings suggest that the clinician's suspicion should be heightened for the possibility of covert child abuse and secondary stress when managing an otherwise apparently healthy child with herpes zoster.