COVID-19 presents in various ways, but mainly as a pulmonary disease (Marzano, 2020). Skin manifestations have been reported, including reactivation of the varicella-zoster virus (Marzano, 2020). Our case report describes two adults developing herpes zoster after vaccination with tozinameran (the Pfizer-BioNTech COVID-19 mRNA vaccine). A possible cause for this reaction is a transient lymphocytopenia that occurs after the vaccination — similar to that in COVID-19 disease (Mulligan, 2020; Wang, 2020; Qin, 2020; Brabilla, 2020; Wang, 2020; Wei, 2017). In the context of vaccinating older and/or immunocompromised adults, our observations can be the starting point for further evaluation of a possible relationship between COVID-19, COVID vaccines, and herpes zoster.
We are in the midst of a severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), or COVID‐19, pandemic. Although COVID-19 presents mainly as a disease affecting the pulmonary system, several skin manifestations have been reported in COVID-19 patients (Marzano, 2020). One remarkable finding is the reactivation of the varicella-zoster virus (VZV), causing herpes zoster (HZ) (Marzano, 2020; Wang, 2020; Qin, 2020; Ferreira, 2020; Tartari, 2020; Elsaie, 2020; Recalcati, 2020; Bhardwaj, 2021). In some patients, HZ was the presenting symptom of COVID-19 infection (Elsaie, 2020). Since December 2020, vaccination programs against COVID-19 have occurred throughout the world. Commonly reported adverse effects are pain at the injection site, fever, nausea, myalgia, and fatigue (http://www.adrreports.eu/ [accessed July 27, 2021]; https://wonder.cdc.gov/vaers.html [accessed July 27, 2021]). This is in concordance with the side-effects mentioned in the product information for tozinameran (the Pfizer BioNTech COVID-19 mRNA vaccine) (Comirnaty, INN-COVID-19 mRNA Vaccine (nucleoside-modified) (https://www.ema.europa.eu/en/documents/product-information/comirnaty-epar-product-information_en.pdf)s [accessed June 8, 2021] Website: Comirnaty, INN-COVID-19 mRNA Vaccine (nucleoside-modified) (europa.eu)s. Accessed June 8, 2021.). Here, we describe a rare side-effect in the form of HZ eruptions in two adults after vaccination with tozinameran.