Herpes zoster–like reaction triggered by the recombinant vaccine against herpes zoster (Shingrix)

IntroductionShingrix (GSK) is a recombinant glycoprotein vaccine proven to be highly effective (97%) in preventing shingles and subsequent postherpetic neuralgia (1).It is recommended for immunocompetent adults age 50 and older, although efficacy is slightly reduced (91%) in those age 70 and above.The vaccine is administered in two intramuscular doses, 2 to 6 months apart (1).Common side effects of Shingrix include localized reactions (pain, redness, and swelling at the injection site) and systemic adverse effects such as myalgia, fever, headache, shivering, fatigue, nausea, and stomach pain (2).Cutaneous side effects account for approximately 27% of all adverse reactions to Shingrix reported in EudraVigilance, the European database of suspected adverse drug reactions.As of July 6th, 2025, there were 24,338 reports of Shingrix-related adverse events (3).Despite the relative frequency of cutaneous side effects, published literature includes only two case reports of dermatomal rash following Shingrix vaccination (4, 5).Here, we describe a third case of zosteriform eruption that could not be definitively classified as either true shingles or an immune-mediated reaction triggered by vaccination. Case reportA 65-year-old Caucasian woman was referred for dermatomal skin rash, pain, and hyperesthesia persisting despite a full course of oral valacyclovir.