Herpes zoster acquired in utero - Case Report- Arch Dis Child published online June 14, 2013.

1. Herpes zoster acquired in utero
A 6-month-old infant presented to our paediatric department
with a low grade pyrexia and rash. There were vesicular lesions
over the left chest and abdominal wall in the T6 dermatome dis-
tribution (figure 1). Investigations revealed a normal C reactive
protein, with raised alanine transaminase of 362 units/l and
white cell count of 19.1×109
/l. On questioning, the mother
revealed that she had developed mild varicella zoster (chicken-
pox) during the 20th–24th week of her pregnancy. The baby
was treated with intravenous acyclovir and flucloxacillin for
5 days with clinical improvement. The sample of fluid sent from
the vesicles for PCR testing was positive for herpes zoster.
Follow-up revealed complete resolution of the rash and normal-
ised blood parameters.
Intrauterine varicella infection before 2 years of age is asso-
ciated with the development of zoster at an early age. Zoster is
an external manifestation due to reactivation of latent varicella
infection in the dorsal root ganglia. Nearly 20% of infants with
intrauterine-acquired varicella zoster virus primary infection
develop herpes zoster in first or second year of life. The
observed risk of zoster when maternal infection occurs before
24 weeks gestation is 0.8% compared with 1.7% if maternal
varicella was after 25 weeks. Early manifestation of herpes
zoster may be explained by the immature cell-mediated immune
response in young children and/or the decrease of maternally
derived antibodies.1
Maternal chickenpox in pregnancy is well
described as the cause of infantile shingles. (The risk is 10-fold
higher than in older children.)2
Rashmi Mehta, Drusilla Ferdinand
Department of Paediatrics, Walsall Healthcare NHS Trust, Walsall, UK
Correspondence to Rashmi Mehta, Department of Paediatrics Walsall Healthcare
NHS Trust, Walsall, UK; rasgharavi@gmail.com
Contributors While RM drafted the article based on the reference provided, DF
had originally seen the child during acute admission, taken the consent, revised the
drafted article and finally approved the version to be published.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
To cite Mehta R, Ferdinand D. Arch Dis Child Published Online First: [please
include Day Month Year] doi:10.1136/archdischild-2013-303959
Accepted 5 April 2013
Arch Dis Child 2013;00:1. doi:10.1136/archdischild-2013-303959
REFERENCES
1 Narkeviciute I, Bernatoniene J. Varicella zoster virus infection in pregnancy,
herpesviridae—a look into this unique family of viruses. Magel GD. 2012. ISBN:
978-953-51- 0186-4, InTech. http://www.intechopen.com/books/herpesviridae-a-
look-into-this-unique-family- of-viruses/varicella-zoster-virus-infection-in-pregnancy
(accessed 23 April 2013).
2 Enders G, Miller E, Cradock-Watson J, et al. Consequences of varicella and herpes
zoster in pregnancy: prospective study of 1739 cases. Lancet 1994;343:1548–51.Figure 1 Vesicular lesions over the left chest and abdominal wall.
Mehta R, et al. Arch Dis Child Month 2013 Vol 00 No 00 1
Images in paediatrics
ADC Online First, published on June 14, 2013 as 10.1136/archdischild-2013-303959
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2. doi: 10.1136/archdischild-2013-303959
published online June 14, 2013Arch Dis Child
Rashmi Mehta and Drusilla Ferdinand
Herpes zoster acquired in utero
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