Herpes Zoster Induced by the Shingrix Vaccine: A Case Report and Literature Review

Herpes zoster (HZ) is a dermatological condition that is caused by the reactivation of the varicella zoster virus (VZV). The recombinant zoster vaccine (RZV; Shingrix, GlaxoSmithKline Biologicals, Rixensart, Belgium) is approved in the United States for the prevention of HZ reactivation in adults aged >50 years. We present a case of a 50-year-old immunocompetent female patient who developed HZ within the first 72 hours post Shingrix vaccination. The patient was evaluated by their primary care provider for a painful, vesicular rash, along with headache and fatigue. A diagnosis of Shingrix vaccine-induced HZ was suspected. A 10-day course of the antiviral acyclovir was initiated. The rash improved after 21 days but then reemerged, and the patient was then given another course of acyclovir. The patient developed post-herpetic neuralgia (PHN) that persisted for several months following resolution of the skin rash. The patient did not receive the second dose of the vaccine. This case highlights a rare adverse effect observed in a patient who received the Shingrix vaccine. The diagnosis of HZ is largely clinical, and therefore vaccine-induced HZ should be suspected when no other cause can be identified. While further studies into vaccine components or patient risk factors that may trigger HZ infection after vaccination are necessary to reduce the development of HZ in the post-vaccination period, the benefits of vaccination still outweigh the risk.