Concurrent Varicella and Herpes Zoster in an Adult Caused by Varicella-Zoster Virus: A Case Report

Introduction

When we hear about chickenpox and shingles, we usually imagine them as two separate chapters of the same book—one in childhood and the other much later in life. But what happens when both chapters collide at the same time? That’s exactly what makes concurrent varicella and herpes zoster in adults such a fascinating and rare clinical phenomenon.

Varicella-zoster virus (VZV) is responsible for both conditions, yet seeing them appear together in a single adult patient is uncommon and often surprising for clinicians. This case report dives deep into such an occurrence, exploring how it happens, why it matters, and what healthcare professionals can learn from it.

Background of Varicella and Herpes Zoster
What Is Varicella (Chickenpox)?

Varicella, commonly known as chickenpox, is typically a childhood illness. It presents with fever, malaise, and a characteristic itchy vesicular rash that spreads across the body. In most healthy children, it’s self-limiting. However, in adults, varicella can be more severe, with higher risks of complications such as pneumonia and secondary bacterial infections.
What Is Herpes Zoster (Shingles)?

Herpes zoster, or shingles, occurs when dormant VZV reactivates years after the initial varicella infection. It usually presents as a painful, unilateral vesicular rash confined to a single dermatome. The pain can be intense, sometimes lingering long after the rash clears—a condition known as postherpetic neuralgia.
Key Differences Between Varicella and Herpes Zoster

Think of varicella as a wildfire spreading across the forest, while herpes zoster is more like a controlled burn in one specific area. Varicella is widespread and systemic; herpes zoster is localised and nerve-specific. Seeing both patterns simultaneously in an adult raises immediate clinical red flags.
Pathophysiology of Varicella-Zoster Virus
Primary Infection and Latency

After the initial varicella infection, VZV doesn’t leave the body. Instead, it retreats quietly into the sensory nerve ganglia, entering a latent state. For years—or even decades—it remains dormant, held in check by the immune system.
Reactivation of the Virus

When immunity wanes due to age, stress, illness, or immunosuppression, the virus can reactivate. This reactivation typically results in herpes zoster. But in rare cases, viral replication may occur more diffusely, leading to concurrent manifestations.
Immune System Role in VZV Reactivation

The immune system is like a security guard. When it’s alert, the virus stays locked away. When it’s distracted or weakened, the virus seizes the opportunity. Concurrent varicella and herpes zoster suggest a temporary but significant lapse in immune surveillance.
Case Presentation
Patient Demographics and Medical History

The patient was a middle-aged adult with no significant chronic illnesses and no known immunodeficiency. There was no recent history of immunosuppressive therapy, malignancy, or HIV infection, making the presentation even more unusual.