Children with Systemic Lupus Erythematosus, Lupus Nephritis May Be at Increased Risk of Herpes Zoster

Complications of varicella-zoster virus in patients with lupus may be attributable to immunological abnormalities, lymphopenia conditions, and immunosuppressive therapies.

Although the onset of herpes zoster is less common in children, those with systemic lupus erythematosus (SLE) and lupus nephritis may be at an increased risk, according to new research.

Herpes zoster is a cutaneous disease that results from the reactivation and multiplication of latent persistent varicella-zoster virus in neuron, following a primary varicella-zoster virus infection. According to researchers, complications such as disseminated herpes zoster are rare, although the prevalence is estimated to be 40% in immunocompromised patients.

A prior study found a reported increase of herpes zoster 1.6 times higher than in patients with lupus nephritis and a rate of disseminated herpes zoster 1.9 times higher than systemic lupus erythematosus. Disseminated herpes zoster is less frequent in children than in adults and is related to immunocompromising conditions.

In a paper published in Infection and Drug Resistance, researchers outlined a case of herpes zoster in a 14-year-old girl with lupus nephritis. According to the paper, before presenting to her physician, the girl had been complaining of painful, red blisters for 4 days. At first, the blisters only appeared on the right leg before spreading throughout the body.

She had been diagnosed with SLE at 3 months of age and was diagnosed with lupus nephritis at 5 months of age. She had received a pulse dose of methylprednisolone 1 g for 3 days, then a maintenance dose of 80 mg every 2 days for 2 weeks before the blisters appeared.

Physicians examined the blisters and found vesicles with an erythematous base, as well as some other confluent vesicles that became well defined bullae with an irregular border and varied in shape and size. Researchers found polymorphonuclear cells and multinucleated giant cells in the bullae, and laboratory tests found anemia, neutrophilia, and lymphopenia.

Based on these findings, the girl was diagnosed with herpes zoster and was given oral acyclovir 5 x 800 mg for 10 days. Clinical improvement was observed following initiation of treatment. Based on her case, however, the authors said herpes zoster may be more common among children with an SLE comorbidity.

Patients with SLE are at a higher risk of experiencing varicella-zoster virus reactivation because of a disturbance of the intrinsic immune system and, frequently, a history of immunosuppressive therapy. Research by Chen et al found that most herpes zoster onset occurred at the beginning of SLE development, with the peak onset between 3 and 6 months following diagnosis with SLE.

Similarly, Nagasawa et al found that nearly half of adult patients in Japan had been diagnosed with herpes zoster in the first year following their SLE diagnosis. In this study, herpes zoster developing to disseminated herpes zoster occurred within 3 months of the SLE diagnosis. Furthermore, SLE and lupus nephritis caused immunocompromised conditions, which were worsened by immunosuppression therapy.

Complications in these patients may be attributable to immunological abnormalities, lymphopenia conditions, and immunosuppressive therapies with high-dose glucocorticoids, according to the paper.

REFERENCE

Widasmara D, Firdausiya F. Disseminated herpes zoster on a child with systemic lupus erythematosus and lupus nephritis. Infection and Drug Resistance. July 20, 2021. Accessed July 26, 2021. https://www.dovepress.com/disseminated-herpes-zoster-on-a-child-with-systemic-lupus-erythematosu-peer-reviewed-fulltext-article-IDR