ArticlePediatric rheumatology online journal2025
Incidence and risk factors of herpes zoster infection in pediatric systemic lupus erythematosus.
Article in Pediatric rheumatology online journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesSystemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease with highly heterogenous clinical manifestations and severity. Herpes zoster (HZ) is a viral disease caused by reactivation of varicella-zoster virus which remains dormant in the dorsal root sensory ganglia after a previous varicella infection. There is limited information on the association between HZ and childhood-onset SLE (cSLE). This study aimed to determine the risk factors for HZ in patients diagnosed with cSLE. PATIENTS AND
methodsSingle-center retrospective cohort study which included all patients less than 19 years old with SLE at a tertiary hospital in the Philippines.
resultsA total of 388 patients were included in the study. The prevalence of HZ was 15.72%, with an incidence rate of 38.40 per 100 person-years. The most common location of the HZ was the upper extremities (18.03%). The median SLEDAI at HZ diagnosis was 4, 16.39% had recurrent HZ, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with HZ (54.10% vs. 40.37%). Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid doses of ≥ 5 mg increased the risk for the development of HZ by 1.61 (p = 0.048), 2.07 (p = 0.009), and 10.20 (p = 0.001) times, respectively.
conclusionThe prevalence and incidence of HZ in cSLE patients are 15.72% and 38.40 per 100 person-years, respectively. The risk factors identified for HZ among cSLE patients were lymphopenia, lupus nephritis, and immunosuppressive agents. Glucocorticoid dosage ≥ 5 mg, azathioprine, and intravenous cyclophosphamide significantly predict the likelihood of developing HZ.
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