The following are the most important diseases or complications that can be caused by herpes zoster (shingles):
Respiratory system (J00-J99)
- Pneumonia (pneumonia)/pneumonitis (esp. in immunosuppressed patients) – Note: typical skin changes show up only with a long latency of up to 14 days.
Eyes and eye appendages (H00-H59).
- Zoster ophthalmicus (affects 10-20% of adult zoster patients) – occurrence of herpes zoster on the face and eyes (ophthalmic nerve from the trigeminal nerve); most common clinical sign is pure zoster dermatitis (inflammatory reaction of the skin caused by herpes zoster) in the area supplied by the ophthalmic nerve. ophthalmicus (50% of cases); other typical symptoms are keratoconjunctivitis (inflammation of the conjunctiva and cornea), blepharitis (inflammation of the eyelid margin) and keratitis (inflammation of the cornea); possible complications include orbital phlegmon (bacterial inflammation of the orbit) with the risk of blindness Note: In case of eye involvement, an immediate presentation to the ophthalmologist is required!
Skin and subcutaneous (L00-L99)
- Eczema herpeticatum with disseminated vesicles – acute, disseminated (“distributed over the body or specific body regions”), large-scale herpes simplex infection.
- Erysipelas (purulent infection of the skin and subcutaneous tissue (subcutis), which in the predominant case is caused by ß-hemolytic group A streptococci (GAS (group A streptococci); Streptococcus pyogenes)) as a bacterial superinfection (secondary infection with bacteria)
- Erythema exsudativum multiforme (synonyms: erythema multiforme, cocard erythema, disc rose) – in the upper corium (dermis) occurring acute inflammation, which leads to typical cocard-shaped lesions; a distinction is made between a minor and a major form.
- Scarring
Cardiovascular system (I00-I99)
- Angiitis – inflammation of the smallest blood vessels; the focus is on small hemorrhages and redness of the skin.
- Apoplexy (stroke)*
- Ischemic infarction was 2.4 times more frequent in the first week after onset of the disease
- In zoster ophthalmicus, the risk of apoplexy is increased 4.5-fold in the first year
- Myocardial infarction (heart attack); increased by a factor of 1.7 (1.47-1.92) in the first week after disease onset; risk decreased gradually in subsequent weeks but was increased overall over a 6-month period after disease onset
- Peripheral arterial occlusive disease (pAVD)* – progressive stenosis (narrowing) or occlusion (closure) of the arteries supplying the arms/ (more commonly) legs, usually due to atherosclerosis (arteriosclerosis, hardening of the arteries) (1.13-fold)
- Giant cell arteritis* – most common form of systemic vasculitis (inflammation of blood vessels) in patients over the age of 50. It belongs to the group of vasculitides (inflammation of blood vessels) (1.99-2.16-fold after severe herpes zoster).
- Vasculopathy (group of primary non-inflammatory vascular diseases of various causes leading to partial or complete occlusion of a vessel) → immediate intravenous antiviral therapy with aciclovir.
- VZV vasculitis – inflammatory diseases of blood vessels caused by varicella zoster virus (VZV).
Infectious and parasitic diseases (A00-B99).
- Bacterial superinfection – on top of the viral infection is still a bacterial infection.
Liver, gallbladder and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).
- Hepatitis (inflammation of the liver) (esp. in immunosuppressed patients) – Note: typical skin changes show only with a large latency of up to 14 days.
Neoplasms* (C00-D48)
- Tumor diseases* : Highest incidence 180 days after herpes zoster diagnosis, lymphomas lead, relative risk for cancer 1.42-1.83-fold
Ears – mastoid process (H60-H95).
- Herpes zoster oticus – secondary manifestation of infection with varicella zoster virus in the ear; affects the facial nerve and/or the vestibulocochlear nerve; clinical presentation: papulovesicles on the pinna and in the external auditory canal.
Psyche – nervous system (F00-F99; G00-G99).
- Acute neuritis (inflammation of the nerves).
- Bell’s palsy (idiopathic peripheral facial palsy) due to involvement of motor branches of the facial nerve come with zoster oticus (involvement of the ear canal and or pinna).
- Encephalitis (inflammation of the brain).
- Meningitis (meningitis)
- Meningoencephalitis – combined inflammation of the brain (encephalitis) and meninges (meningitis) (esp. in immunocompromised patients) – Note: typical skin changes show only with a long latency of up to 14 days.
- Parkinson’s disease* (1.17-fold).
- Myelitis (inflammation of the spinal cord), ascending, with or without paralysis.
- Postherpetic neuralgia (PHN; synonyms: postzoster neuropathy; postzoster neuralgia, PZN); belongs to the orofacial pain syndrome – nerve pain after herpes zoster disease; these are associated with persistent pain even six months after healing of herpes zoster; the risk of PHN increases with age [especially over 50-year-olds (12-25%)].
- Ramsay-Hunt syndrome – neuralgia and facial nerve palsy in the setting of zoster oticus with involvement of the geniculate ganglion and intermediary nerve.
- Sensory disturbances within the affected dermatome (skin area).
- Cerebellitis (inflammation of the cerebellum)
- CNS involvement (involvement of the central nervous system) → immediate intravenous antiviral therapy with aciclovir.
Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).
- Neurogenic bladder disorders
Digestive system (K00-K93)
- Abdominal wall hernia (opening or a weak spot in the abdominal wall through which viscera in the abdominal cavity can leak) in the setting of abdominal wall paralysis
* Diseases whose risk increases with herpes zoster disease.
