Herpes Zoster in a 9-Month-Old Immunocompetent Infant

Herpes zoster (HZ), caused by varicella-zoster virus (VZV) reactivation, is rare in infants, typically linked to maternal VZV exposure during pregnancy. This case describes HZ presentation in a healthy infant without a clear exposure history. A 9-month-old immunocompetent female presented with a two-day fever and unilateral, dermatomal rash of vesicular lesions along the C5 dermatome. Initial misdiagnoses of insect bites or eczema delayed treatment. Diagnostic tests, including Tzanck smear showing multinucleated giant cells, confirmed HZ, with normal blood counts and negative maternal VZV antibodies, suggesting subclinical primary infection. Oral acyclovir (20 mg/kg/dose, five times daily for seven days) led to full recovery without complications. This case highlights HZ as a rare but important differential diagnosis for unilateral vesicular rashes in infants. It underscores the need for research into VZV reactivation mechanisms in early childhood.