Discussion
The concern about the association between the COVID and HZ was raised[2, 3]. The clinical manifestations of COVID-19 were detected in asymptomatic cases to severe clinical symptoms with a major impact on the respiratory system[5]. Furthermore, HZ may appear in completely asymptomatic COVID-19 patients [6].
Recently, few reports of reactivation of herpes zoster during Covid-19 infection were published.
Elsaie et al. reported a HZ lesion in 2 patients with COVID-19 with mild or no respiratory symptoms and no history of contact with known or suspected COVID19 cases[3].
Desai et al reported unilateral vesicular painful rashes along the dermatomes T-11-12 in a patient with COVID-19 infection. The lesions were detected 6 weeks after the COVID-19 symptoms started[2]. However, we detected the HZ lesion 10 days after COVID-19 symptoms started.
We believe that few reports of herpes zoster in COVID-19 patients are due to many factors as a full evaluation of patients with COVID-19 in terms of oral mucosa is not commonly performed due to the severity of the diseases. In addition, it may be difficult for clinicians to detect those lesions in patients without painful symptoms.
Increased incidence of HZ during COVID-19 outbreak may be related to the intense stress during the infection and the altered immunity during the pandemic[7]. Biopsy wasn’t performed on our patient however we recommend further research in the form of well-designed studies to be conducted to establish whether COVID-19 raises the risk of HZ. Health practitioners should be concerned about the probably risen incidence of HZ during COVID-19 pandemic and consider appropriate therapeutic and protective measures against it.
CONFLICT OF INTEREST: The authors declare no conflicts of interest.
Sources of funding for your research: There are no funding sources or sponsors related to the present work.
Patient’s consent: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Authors contribution: All authors had a role in writing and revising this manuscript