To describe a case of reactivation of Varicella-Zoster virus after COVID-19 infection and/or vaccination.

COVID-19 is caused by the SARS-CoV-2 virus and generally manifests through respiratory symptoms. Immunocompromised communities and individuals over the age of 60 are most susceptible to COVID-19 contraction. Varicella-Zoster Virus (VZV) is a herpes virus that causes chickenpox and herpes zoster (shingles). Shingles is characterized by a maculopapular vesicular rash, scabs, and pain accompanied by sensory loss.

Patient 1, a 60-year-old male, presented to our institution with itching, localized rashes, and muscle pain. Patient 2, an 80-year-old male, presented with blisters and pain in the affected areas. Patient 1 was diagnosed with COVID-19 and Patient 2 received the COVID-19 vaccination prior to the onset of these symptoms.Both patients received two full doses and the booster dose of the mRNA COVID-19 vaccine.

After testing was conducted, both patients were diagnosed with post herpetic neuralgia (PHN), a neurological condition that damages nerve fibers due to shingles-induced inflammation. Both patients tested positive for shingles. MRI of the brain was normal.

COVID-19 weakens cellular immunity and can lead to bacterial and viral super-infections. VZV reactivation thrives on cellular declines related to age and immunosuppression. Symptoms of VZV appear as a long-term effect. Researchers posit that COVID-19 can lead to the onset of VZV due to its ability to compromise the immune system and initiate elevated levels of Th17 cells and interleukin-17. Whether the reactivation is more related to COVID-19 infection or the vaccination is still unknown.Our findings hope to bring awareness to the additional risks faced by older individuals after exposure to COVID-19. Understanding the mechanisms of association between the two viruses can help clinicians identify and control uncommon adverse events. The COVID-19 vaccination, however, is safe and recommended for all age groups.