varicella zoster vaccine

Dermatome-Specific Herpes Zoster Following Corticosteroid Therapy for Lumbar Disc Herniation: A Case Report Illustrating the Immunocompromised District Theory.

Liu Jun J, Luo Lili L, Zhou Ming M, Chen Weifeng W et al.

Systemic corticosteroids frequently utilized to manage lumbosacral radiculopathy introduce an immunological paradox by potentially triggering varicella-zoster virus reactivation. While well-documented in severely immunocompromised populations, the specific neuro-immunological mechanisms in otherwise immunocompetent patients with lumbar disc herniation remain underappreciated. This case presents an observation conceptually relevant to the "Immunocompromised District" theory, proposing a theoretical link between acute radicular compression and a localized vulnerability that may correlate with the precise anatomical distribution of a viral outbreak. A 52-year-old male presented with acute mechanical right-sided lumbar and anterior thigh pain. Magnetic resonance imaging revealed an acute L3-L4 disc herniation compressing the L4 nerve root, coexisting with an asymptomatic chronic L4-L5 herniation. Four days after initiating intravenous dexamethasone, the patient experienced a sudden phenotypic shift in symptoms: the mechanical dullness transformed into severe, electric-shock-like neuropathic pain. This heralded a herpes zoster eruption remarkably confined to the acutely symptomatic L4 dermatome, completely sparing the chronically compressed L5 region. Following corticosteroid discontinuation and initiation of antiviral therapy, the lesions resolved within 1 week, leaving mild post-herpetic neuralgia at the one-month follow-up. Given the lack of objective molecular data, we hypothesize a multifactorial pathogenesis for this phenomenon. A theoretical "double hit" mechanism-comprising corticosteroid-induced systemic immunosuppression and localized vulnerability from acute radiculopathy-may potentially facilitate viral reactivation in a susceptible host (e.g., possessing age-related and metabolic risk factors). Clinically, a sudden qualitative shift in pain phenotype from mechanical to neuropathic during steroid therapy for lumbar degeneration may serve as an early clinical clue of impending herpes zoster. Recognizing this dynamic prevents misinterpreting viral prodromes as mechanical exacerbations, thereby avoiding the detrimental escalation of immunosuppressive therapy.

When Vaccination Meets Infection Prevention: National Practices for Inpatient Administration of Measles-Mumps-Rubella, Varicella, and Rotavirus Vaccines.

Altez Maria Susana Rueda MSR, Hutto Celia C, Hobby-Noland Delphene D, Song Xiaoyan X

Zosteriform Cutaneous Metastasis of Lung Adenocarcinoma Mimicking Herpes Zoster: A Diagnostic Pitfall.

Gazal Ela E, Türsen Ümit Ü, Yuyucu Karabulut Yasemin Y

Zosteriform cutaneous metastasis from lung cancer is rare, but dermatomal distribution can lead to diagnostic anchoring on herpes zoster. A 65-year-old man with metastatic lung adenocarcinoma presented with a one-month history of painless, nonvesicular papules confined to the left T7-T9 dermatomes. Herpes zoster was initially suspected because of the striking unilateral dermatomal distribution and the patient's oncologic treatment-related immunosuppression, despite the absence of pain, vesiculation, and crusting. Oral valacyclovir was prescribed. The patient did not attend the planned one-week follow-up and next presented approximately six months later, when the eruption had progressed to extensive infiltrated violaceous papules and plaques spanning T2-T10. Histopathologic examination showed dermal infiltration by malignant gland-forming epithelial cells with lymphovascular invasion, and nuclear thyroid transcription factor-1 positivity supported pulmonary origin. The patient died approximately seven months following the diagnosis of cutaneous metastasis. This case documents the progression of initially limited zosteriform lesions to extensive infiltrative cutaneous metastases. In patients with malignancy, dermatomal distribution should not outweigh discordant morphology or clinical behavior; painless, nonvesicular, persistent, or progressive eruptions warrant early biopsy.

Effects of pricking-and-cupping bloodletting therapy on pain and skin lesions in patients with herpes zoster: a systematic review and meta-analysis.

Peng Pei P, Jiang Chengting C, Wu Min M, Zhong Pengcheng P

To systematically assess the effectiveness and safety of pricking-and-cupping bloodletting therapy in relieving pain and improving skin lesion outcomes in herpes zoster (HZ) patients. All randomized controlled trials (RCTs) exploring the therapy's impact on HZ-related pain and skin lesions were identified through a comprehensive electronic search of CNKI, VIP, Wanfang, SinoMed, PubMed, EMBASE, Web of Science, and the Cochrane Library, with the search period ranging from each database's establishment until November 2025. Included studies were assessed for quality via Cochrane Risk of Bias tool, followed by meta-analysis with Stata MP 19.5. The evidence certainty for each outcome was graded via the GRADE framework. PROSPERO Registration: CRD420251267768。. A total of 31 studies involving 2,443 patients were ultimately included in the meta-analysis. The pooled analysis demonstrated that, compared with conventional Western medicine, pricking-and-cupping bloodletting therapy yielded superior outcomes across multiple endpoints. These included Visual Analogue Scale (VAS) pain scores [SMD = -1.59, 95% CI (-2.13, -1.05), p < 0.001], overall response rate [RR = 1.12, 95% CI (1.04, 1.19), p = 0.001], time to cessation of vesicles [SMD = -0.96, 95% CI (-1.34, -0.58), p < 0.001], time to crust formation [SMD = -1.29, 95% CI (-1.74, -0.84), p < 0.001], time to pain relief [SMD = -5.93, 95% CI (-6.62, -5.25), p < 0.001], and the incidence of postherpetic neuralgia (PHN) [RR = 0.14, 95% CI (0.07, 0.27), p < 0.001]. Pricking-and-cupping bloodletting therapy shows a relative benefit in shortening the time to pain relief, accelerating skin lesion healing, and reducing the incidence of postherpetic neuralgia (PHN) in patients with herpes zoster. However, given the very low certainty of evidence as assessed by the GRADE framework, clinical interpretation should be cautious. Rigorous, large-sample, multicenter randomized controlled trials are urgently needed to validate its efficacy and strengthen the reliability of clinical evidence. https://www.crd.york.ac.uk/PROSPERO/search, identifier CRD420251267768.