[CIS-PAGID] Adult with recurrent "Zoster"

[Jason W. Caldwell]

Maybe look at a VZV titer first.  If it is positive, I wouldn't think the vaccine would be helpful.  When we get new jobs and our titers are checked, people are not boosted if the titers are positive.

Jason W. Caldwell DO
Assistant Professor of Internal Medicine & Pediatrics
Section Pulmonary, Critical Care, Allergy, and Immunological Diseases
Wake Forest University School of Medicine
Medical Center Boulevard
Winston-Salem, North Carolina, 27157
Office Phone: 336-716-5166
Fax:  336-716-7277
E-mail:  jcaldwel at wfubmc.edu

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Church, Joseph
Sent: Tuesday, January 04, 2011 11:00 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [CIS-PAGID] Adult with recurrent "Zoster"

Thank you all for your comments and suggestions regarding the patient described below.

A fellow rotating with us suggested we immunize him with VZV vaccine.  Opinions?

Joe Church

________________________________
From: Church, Joseph
Sent: Wednesday, December 29, 2010 4:09 PM
To: 'pagid at list.clinimmsoc.org'
Subject: Adult with recurrent "Zoster"

Colleagues:

A 57yo man was referred for recurrent Herpes zoster.   Lesions have recurred ~ 2 times a year for 20 years.  They affect the same facial location (right ear).  Outbreaks are associated with increased stress and missing Valtrex prophylaxis.  He has absolutely no other infectious history and is otherwise healthy.

NORMAL laboratory findings include the following:

  *   CBC, CMP, sed rate, CRP
  *   IgG, IgA, IgM
  *   Antibody responses to tetanus, hepatitis A and Pneumovaxtm
  *   T, B and NK numbers
  *   PHA and PWM LPAs
  *   Tetanus, Candida and VZV LPAs
  *   NK cytotoxicity (Cincinnati Children's)
  *   CTL cytotoxicity (Cincinnati Children's)

Other than the possibility that these episodes are not VZV-related, does anyone have any other ideas?

Joe Church
Children's Hospital Los Angeles



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