Disseminated Varicella-Zoster Virus Infection Following a Live Attenuated Varicella Vaccine (Oka Strain) in a Patient with Rheumatoid Arthritis: A Case Report

A 77-year-old woman was being treated for rheumatoid arthritis with prednisolone, methotrexate, and iguratimod. The patient was administered a live-attenuated varicella vaccine (Oka strain) for herpes zoster prevention by a primary care physician. Four weeks later, a vesicular rash appeared on the body. The patient was treated with amenamevir, and the rash improved. Based on the pathological findings and viral genotyping, she was diagnosed with a vaccine-induced disseminated varicella-zoster virus infection. For herpes zoster vaccination, caution is warranted as some medical questionnaires for vaccination do not include glucocorticoid use or immunosuppressive therapy, and some primary care physicians administer live vaccines only.