Infantile herpes zoster after intrauterine exposure to varicella infection.

Herpes zoster as a reactivated phase of chickenpox is very rare in infancy due to the protective effect of the maternal immunity against the virus.1,2 Overall rate of zoster is 3.40 cases per 1000 persons. The lowest incidence is less than 10 years old (0.74/1000) per year. The earliest age reported is in a 3-month old infant.3 Herein we present a 3 month-old otherwise healthy boy with herpes zoster who acquired primary infection in uterus from his mother. This male infant was delivered by means of normal vaginal after 37 weeks’ gestation with 3500g weighed and 42 cm height. His 21-year-old mother (gravida 1, para 1) had been exposed to varicella zoster virus (VZV) during week 24 from her brother and sister with no history of getting VZV immunoglobulin. Patient presented to our outpatient department with a 4-day history of grouped vesicular eruption and was not associated with fever and irritability. Physical examination revealed a healthy excess crying child with unilateral, grouped fluid-filled vesicular eruption in a band or dermatomal distribution involving the left upper back; the vesicles progressed to involve the left upper abdomen (Figure 1 and 2). Our patient's diagnosis was confirmed by Tzanck smear. It demonstrated acantolytic keratinocytes with hemogenous pale chromatin of nucleous, some with eosinophilic inclusion body surrounded by a halo (Ballon cells). The patient was followed and advised to hygiene of the skin. The lesions were resolved without scaring. Although the primary varicella infection is usually acquired in childhood and reactivation of virus usually is seen in elderly, it can also occur in infancy followed by reactivation of primary varicella infection acquired in uterus or in early infancy.2,4 Figure 1. Herpes zoster Figure 2. Dermatomal vesicular eruption of herpes zoster