Abstract
The recombinant zoster vaccine (Shingrix) was recently approved for the prevention of herpes zoster reactivation in adults aged ≥ 50 years. While its effectiveness has been widely demonstrated, its safety profile and potential adverse effects remain uncertain. We report the first case of lupus induced by the Shingrix vaccine. An 85-year-old woman was evaluated in the hospital due to a pleuropericarditis with pleural and pericardial effusion. Test for anti-nuclear antibody was positive at a titer of 1:640 with a homogeneous pattern, as well as for IgG anti-cardiolipin antibodies. Infectious or malignant etiologies were excluded. A diagnosis of Shingrix vaccine-induced lupus was suspected, and a short course of prednisone was initiated. The patient's symptoms resolved within the first two months, and after one year of follow-up, both the antinuclear and anti-cardiolipin IgG antibodies were negative. Although many drug categories have been associated with the development of drug-induced lupus erythematosus (DILE), it remains unclear whether vaccine-induced immune system upregulation could trigger the onset of systemic lupus. However, particularly after the introduction of the SARS-CoV2 vaccine, cases of cutaneous and systemic lupus induced by vaccines have been reported, and the serological pattern appears to be different from that observed in drug-induced lupus. Our case details a critical adverse effect observed in a patient who received the zoster vaccine. This finding is particularly relevant given the ongoing widespread vaccination campaigns and the global public health implications. Vaccine-induced lupus should be suspected following vaccination in the presence of cutaneous or systemic lupus symptoms, particularly serositis or renal involvement, when no other cause can be identified. The diagnosis is supported by positive antinuclear antibodies and other laboratory abnormalities, such as decreased complement levels or positivity for other antibodies, including antiphospholipid antibodies. Key Points • The varicella-zoster vaccine will be administered to a large percentage of the population, which could lead to an increase in adverse effects that have not yet been described. This article reports the first documented case of lupus induced by the varicella-zoster vaccine. • The diagnosis of Drug-induced lupus erythematosus (DILE) requires a low threshold of suspicion. • Clinical manifestations in DILE are usually milder, and it often presents with general symptoms, arthralgia, serositis, and hematologic abnormalities. • The autoimmune profile of vaccine-induced lupus appears to differ from that of drug-induced lupus, being characterized by a higher frequency of positive antinuclear antibodies (ANA), antiphospholipid antibodies, and hypocomplementemia, with a lower prevalence of anti-histone antibodies.