[CIS PIDD] Adult with recurrent HSV-1 and VZV infections

[Howard Lederman]

I have just seen a 36 y/o female who was healthy until 18 months ago when she began to develop recurrent episodes of peri-oral HSV outbreaks as well as multiple episodes of shingles.  None of the infections has been terribly severe, but she does have post-infectious neuralgias.  She has otherwise been well except for a long h/o mild environmental allergies and intermittent sinus infections.  She has no HIV risk factors.

Lab tests have shown normal IgG, IgA, IgM;  IgG Ab to HSV-1 (but not HSV-2), VZV, and a strong response to a recent Pneumovax; normal T-cells: 83% CD3 (2144 /uL) / 38% CD4 (997/uL) / 38% CD8 (986/uL; normal NK numbers:  6%CD16/CD56; and negative HIV ELISA.  CBC completely normal except for mild anemia (Hgb l0.7).

Is there any additional testing that may yield useful information to explain this problem acquired so late in life?

Has anyone tried to immunize such a patient with Zostavax in the hope that it would stimulate anti-VZV immunity better than a viral re-activation?

Howard
Howard M. Lederman, M.D., Ph.D.
Professor of Pediatrics, Medicine and Pathology Division of Pediatric Allergy and Immunology Johns Hopkins Hospital - CMSC 1102 600 N. Wolfe Street Baltimore, MD 21287-3923
Phone: 410-955-5883
Fax: 410-955-0229
Email: Hlederm1 at jhmi.edu<mailto:Hlederm1 at jhmi.edu>

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