key: cord-0709625-dglp4buf
authors: Bernardini, Nicoletta; Skroza, Nevena; Mambrin, Alessandra; Proietti, Ilaria; Marchesiello, Anna; Marraffa, Federica; Rossi, Giovanni; Volpe, Salvatore; Tolino, Ersilia; Potenza, Concetta
title: Herpes zoster ophthalmicus in two women after Pfizer–BioNTech (BNT162b2) vaccine
date: 2021-10-07
journal: J Med Virol
DOI: 10.1002/jmv.27366
sha: 8d75c7ddb6fd0b3106c3b931885d0374bebeae5f
doc_id: 709625
cord_uid: dglp4buf

nan

It has been shown to be safe and effective by conferring 95% protection against COVID-19. 1 However, there are few adverse events; the most described are pain at the injection site, fatigue, and headache. 2 Herein, we report two cases of herpes zoster ophthalmicus (HZO) following COVID-19 vaccination.

An 80-year-old woman with a history of breast cancer diagnosed in 2018 was referred to us for erythematous, pruritic, and painful blistering rash localized to the right side of the forehead and scalp. She also presented eyelid edema of the right eye ( Several cases of HZ have been described in Pfizer vaccine recipients, however, only one of them with ophthalmic localization, in a 56-year-old woman with rheumatoid arthritis. 5 We report two cases of postvaccine HZO although a rarely reported adverse event with potentially serious consequences.

HZO was also diagnosed in four patients suffering from a moderate form of COVID-19 infection 6 that were effectively treated with antivirals without any visual sequelae. In these cases, the triggering factor for viral reactivation is probably due to lymphopenia secondary to SARS-CoV-2.

The close temporal proximity between the administration of the vaccine and the onset of symptoms has assumed a causal relationship between the two events. The underlying mechanism could be identified in vaccine-induced immunomodulation. In fact, the mRNA vaccine determines an abundant production of I INF which can lead to a dysfunctional TCD8+ response and TCD8+ exhaustation. 7 Further epidemiological studies are needed to confirm the link between mRNA vaccination and HZ reactivation.

It can be concluded that the vaccination is safe since in neither case, the disease did not show complications. However, it is necessary to take into account this possible side effect to start immediately the correct therapy.

F I G U R E 1 Vescicular rash that involves the right ophthalmic division of the fifth cranial nerve and edema of the right eyelid F I G U R E 2 Erythema and blisters on the left forehead, edema of the left eye, and Hutchinson's sign (involvement of the tip of the nose) (black arrow)

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