Herpes zoster in juvenile-onset systemic lupus erythematosus - Incidence, clinical characteristics and risk factors

Background: Herpes zoster (HZ) is common in systemic lupus erythematosus (SLE) patients, but its clinical features and risk factors in juvenile-onset SLE have not been well described before. Methods: A retrospective review of the clinical course and infections in pediatric SLE patients managed in our institution from 1988-2004 was performed. Clinical characteristics and potential risk factors for HZ were analyzed. Results: Forty-nine children with SLE were identified. Nineteen episodes of HZ were recorded in 15 patients, and 2 of them had recurrent HZ. The incidence rate was 58.7 episodes/1000 patient-years. No patient had disseminated HZ, postherpetic neuralgia, or cutaneous scarring, and no death was attributed to HZ. Most (63.2%) HZ occurred within 6 months from onset of SLE or disease flare-up. There was no significant difference in age of onset of SLE, gender, disease duration, use of high dose steroid, or other immunosuppressive agents in patients with and without HZ. Patients with HZ were more likely to have prior or concurrent lupus nephritis (86.7%) than those without HZ (58.5%) (P = 0.096). Occurrence of other major infections was also significantly more common in those who had HZ (80.0%) than those without (32.3%) (P = 0.006). Conclusions: Herpes zoster was common in juvenile-onset SLE patients. Most were benign, without systemic dissemination and postherpetic neuralgia. SLE patients with renal involvement and heightened lupus activity were at greater risk of having HZ. Those with HZ were also more likely to have other major infections during their disease course.