Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2022; 10(24): 8703-8708
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8703
Recurrent herpes zoster in a rheumatoid arthritis patient treated with tofacitinib: A case report and review of the literature
Qing-Xia Lin, Hui-Juan Meng, Yun-Yan Pang, Yan Qu
Qing-Xia Lin, Hui-Juan Meng, Yun-Yan Pang, Yan Qu, Department of Dermatology, The Affiliated Hospital of Weifang Medical University, Weifang 261031, Shandong Province, China
Author contributions: Lin QX and Meng HJ served as the patient’s dermatologists during hospitalization; Pang YY was responsible for the data collection; Lin QX contributed to manuscript drafting and continuous writing of the paper; Qu Y was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by the Doctoral Startup Fund of Affiliated Hospital of Weifang Medical University, No. 2021BKQ01.
Informed consent statement: Informed consent was obtained from the patient and her family for the publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Qu, MD, PhD, Associate Chief Physician, Postdoc, Department of Dermatology, The Affiliated Hospital of Weifang Medical University, No. 2428, Yuhe Road, Weifang 261031, Shandong Province, China. fyquyan@wfmc.edu.cn
Received: March 4, 2022
Peer-review started: March 4, 2022
First decision: June 7, 2022
Revised: June 16, 2022
Accepted: July 21, 2022
Article in press: July 21, 2022
Published online: August 26, 2022
Processing time: 164 Days and 17.3 Hours
Abstract
BACKGROUND

Tofacitinib is an oral Janus kinase (JAK) inhibitor that is currently approved by the United States Food and Drug Administration for the treatment of rheumatoid arthritis (RA). Varicella zoster virus reactivation leading to herpes zoster (HZ) is an adverse effect of this drug; however, recurrent HZ at the same site is a rare clinical condition.

CASE SUMMARY

A 70-year-old female RA patient had undergone 1-year of tofacitinib treatment (10 mg daily). About 1 mo after initiation of oral tofacitinib, she developed blisters on the left flank and abdomen and was diagnosed with HZ; antiviral therapy with acyclovir was resolutory. However, 5 d prior to presentation at our hospital, erythema and blisters with severe pain recurred at the same site. Small clustered blisters and bullous were visible on the left lumbar abdomen and perineum, with a pain score of 8 (visual analogue scale). Antiviral, nutritional supplement, analgesic and other treatments led to healing but over an atypically long period (approximately 26 d, vs approximately 1 wk). HZ is a common and serious adverse reaction of JAK inhibitors, but it rarely recurs. Our patient’s experience of HZ recurrence at the same site, with a wider affected area, more severe pain and longer healing period, is inconsistent with previous reports.

CONCLUSION

Same-anatomical site HZ recurrence may occur during oral tofacitinib treatment, with more severe clinical manifestations than in the initial occurrence.

Keywords: Tofacitinib; Herpes zoster; Varicella zoster virus; Recurrent infection; Case report

Core Tip: Herpes zoster (HZ) is caused by the reactivation of varicella zoster virus. We report a case of recurrent HZ in a patient with rheumatoid arthritis treated with oral tofacitinib. This patient’s HZ recurred at the same site, with a wider affected area and more significant pain than the first occurrence. After antiviral therapy, the rash slowly resolved. The characteristics of this case are different to those of HZ induced by tofacitinib summarized and analyzed in the literature. We hope that our report will prompt clinicians to standardize the diagnosis and treatment of HZ during tofacitinib therapy.