Recently, a pediatrician consulted me on a 13 year old with shingles. The patient had been vaccinated with the live attenuated vaccine as a younger child. Patient responded nicely to a course of valacyclovir (antiviral medication).
The case got me thinking about two things: first, in my experience, shingles in children is very unusual. Epidemiologic data supports the rarity to about 1 case for every 1000 people aged 1-25 per year.
Second, it got me thinking about the pathogenesis (how the process works). It must be that the latent live attenuated virus can set up shop in the spinal cord. Over time, the patient’s ability to detect varicella zoster may wane. In these cases, the virus escapes local control, resulting in findings called shingles.
This patient’s pediatrician and I ran the case by an infectious disease specialist. The specialist thought that it would be wise to check the patient’s CBC, specifically the lymphocyte count. We wanted to make sure there were no underlying conditions.
Albrecht MA. Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster. Hirsch MS, Mitty J, eds. http://www.uptodate.com/contents/epidemiology-and-pathogenesis-of-varicella-zoster-virus-infection-herpes-zoster?source=search_result&search=Epidemiology and pathogenesis of varicella-zoster virus infection%3A Herpes zoster&selectedTitle=1~150. Accessed May 19, 2017.