Shingles During Childhood?

Is it possible for children to come down with shingles? I recently saw a 2 year old with a most interesting history who then developed a weird rash.   Funny thing, I read an article shortly after seeing this child that described his case perfectly, only wish I had seen this the week before.

So, this 2 year old complained that his leg hurt. Enough pain that he limped and woke up at night crying that his thigh hurt. He had no history of trauma and also was otherwise well, in other words no fever, vomiting, cold symptoms etc.

After several days of watching him without resolution of his pain the mother noticed 3 little spots on his thigh, which she thought might be a bite. The little boy was seen and the diagnosis of herpes zoster (shingles) was considered.  In children the differential diagnosis of localized leg pain in the absence of a rash would not normally include shingles.

According to the pedi dermatologist (that I consulted) shingles in children occurs more frequently on their lower extremities (not for adults) and may involve the back on the same side.   Unlike adults, most cases of zoster in children are only mildly painful and resolve fairly quickly.

Well, this little boy didn't read the book and his rash continued to get worse and spread, and was quite painful for days. Prior to this, he was a perfectly healthy little boy and had received his first varicella vaccine when he was 1.  

Since the widespread use of the varicella vaccine (chickenpox vaccine, see old post), the incidence of chickenpox has decreased dramatically, and vaccination should also reduce the risk of developing shingles later in life. In otherwise healthy children shingles (zoster) tends to develop at a younger age among vaccinated children than in those who have had a natural chickenpox infection.  When shingles occurs after vaccination it represents either a new infection with wild-type virus (an exposure to chickenpox or shingles) or reactivation of the vaccine virus.

Once a child has received 2 doses of varicella vaccine as recommended, the immunity is boosted and should further reduce the risk of developing shingles. Varicella zoster virus can be transmitted via contact with skin lesions of those who have either chickenpox or shingles.  Infection is less likely after exposure to shingles. Transmission of the virus occurs until all lesions have crusted over. In this case, the little boy was ultimately started on an oral anti-viral therapy with slow resolution of his rash and pain and a return to normal around his house.

Note to self, weird pain may precede the rash in herpes zoster by several days.  Even though unusual, herpes zoster may occur in a healthy child who no history of varicella exposure and who has received all or part of their chickenpox vaccine.

That's your daily dose for today. We'll chat again tomorrow.