Reactivation of Varicella-Zoster Virus Keratitis after Recombinant Herpes Zoster Vaccination: A Case Report and Literature Review.

INTRODUCTION

Varicella-zoster virus (VZV) keratitis following recombinant herpes zoster (HZ) vaccination is rare, and its underlying mechanisms remain poorly understood. Sporadic cases of ocular inflammatory reactivation have been reported after vaccination, particularly in patients with a history of HZ infection.

CASE PRESENTATION: A 68-year-old woman with a history of trigeminal HZ without prior corneal involvement developed VZV keratitis 2 months after receiving the recombinant HZ vaccine (Shingrix®). The condition progressed to neurotrophic keratitis, requiring advanced ocular surface therapy, including autologous serum and topical insulin, with favorable visual and symptomatic outcomes.

CONCLUSION

Reactivation of VZV keratitis after HZ vaccination is an uncommon but clinically relevant event. Ocular reactivation may occur even in patients without previous corneal involvement and may lead to chronic complications, supporting the need for close ophthalmologic follow-up in patients with a history of HZ infection.