key: cord-0890614-1khuu2m5
authors: Nofal, Ahmad; Fawzy, Mohamed M.; Sharaf EL Deen, Sherif M.; El‐Hawary, Esraa E.
title: Herpes zoster ophthalmicus in COVID‐19 patients
date: 2020-10-11
journal: Int J Dermatol
DOI: 10.1111/ijd.15240
sha: 1011feec6801c27447cbce8c596d4ba480eac0db
doc_id: 890614
cord_uid: 1khuu2m5

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erythematous base and dermatomal pain distribution, in addition to ocular manifestations such as conjunctivitis, uveitis, episcleritis, keratitis, and retinitis. Risk factors for reactivation of varicella zoster virus (VZV) include old age, immunocompromised conditions such as autoimmune diseases, and chronic diseases such as diabetes mellitus. 1 Several skin manifestations have been reported in COVID-19 patients, including HZ. 2 To the best of our knowledge, HZO has not been previously reported in COVID-19 patients. Herein, we present four cases of HZO in two children and two young adults infected with this pandemic disease.

The age of our patients ranged from 7 to 42 years with a mean of 21.5 years. All the patients reported a previous episode of chickenpox at a younger age. At the onset of HZO presentation, the patients were immunocompetent and had mild to moderate COVID-19 disease manifestations, including fever, malaise, bone aches, sore throat, dry cough, diarrhea, and loss of taste. The disease was confirmed using a nasopharyngeal smear test, and a complete blood count revealed mild/moderate lymphopenia with a mean of 0.904 9 10 3 /ul (normal value: 1.5-4 9 10 3 /ul for adults, 1.5-9 10 3 /ul for children). The patients received supportive and symptomatic treatment for COVID-19 and did not require hospitalization. The mean time between the onset of COVID-19 disease and HZO diagnosis was 4.5 days (Table 1) .

Herpes zoster ophthalmicus is rarely reported in childhood, particularly in immunocompetent children. Most of the reported cases are related to varicella infection acquired during the first year of life or intrauterine and children with immunosuppression. 3 Therefore, it was quite interesting to diagnose HZO at this young age (7 and 9 years) ( Figure 1a ). 

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