HSV and varicella zoster virus (VZV) cause downregulation of NKG2D ligands on neural cell membranes and terminals after infection of these cells, so the infected cells could not be recognized with natural killer cells, and the HSV or VZV infection enters its latent phase. 5, 6 This might be explained through the function of natural killer group 2D (NKG2D) ligands which are also known as “stress‐induced ligands”, found on healthy cells, such as neuronal cells, in order to avoid auto‐reactivity of natural killer T cells against normal tissues. Since the onset of COVID‐19 pandemic, herpes simplex, or herpes zoster‐like lesions have been reported during COVID‐19 infection. We reported a 28‐year‐old man who developed herpes‐like skin lesions as vesicular ulcerative periorbital lesion 48 h after the first dose of AZD1222 vaccine against COVID‐19. Seven days after the onset of the lesion, signs and symptoms disappeared, and treatments were discontinued. After 72 h, the patient reported blurred vision on the right eye. Topical antibiotic therapy was administered for the patient including sulfacetamide 10% eye drop to treat probable bacterial superimposition and conjunctivitis and blepharitis because of severe periorbital edema and ketotifen eye drop, Vitamin A ointment to reduce itching and irritation. Regarding clinical signs and symptoms and patient history, treatment was started based on the diagnosis of recurrent HSV lesion of the upper eyelid. According to the patient, he has experienced periods of cold sore (herpes simplex labialis) ever since. Along with these findings, patient reported a history of a herpes simplex virus (HSV) infection following a trauma to the right eye with an object in his childhood. Ocular examination was done by slit‐lamp, which showed normal findings. Besides the common post‐vaccination signs and symptoms, 2 days later, burning sensation, and painful skin rashes, and blisters developed on his right upper eyelid (Figure 1) followed by upper eyelid edema 3 days later (Figure 2). He received first dose AZD1222 vaccine on March 20, 2021, during the Iran national vaccination program. In this study, we are going to report a herpes‐like skin lesion following AZD1222 vaccination.Ī 28‐year‐old man, with no systemic disease, presented with herpes‐like skin lesions on his right upper eyelid. 3 To our knowledge, herpes‐like skin lesions have not been reported in the azd1222 vaccine clinical trials, 4 but some spontaneous reports in this regard from the UK have been received between April 1 and July 21, 2021. Herpes virus reactivation has been reported following trivalent influenza, hepatitis A, and rabies vaccines, suggesting vaccine‐modulated immunomodulation. Furer et al, have reported six cases of herpes zoster following BNT162b2 mRNA COVID‐19 vaccination. 1 Viral infections after COVID‐19 vaccination have been reported. Chadox1 ncov‐19 (AZD1222) is one of them, which has been used in the national vaccination programs against the disease in many countries. Up to now, more than 50 vaccines against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have been developed and presented in clinical trials. Since coronavirus disease 2019 (COVID‐19), pandemic, safe, and effective vaccination against it became vital. This study reports a case of herpes‐like skin lesions after chadox1 ncov‐19 (azd1222) vaccine in a 28‐year‐old man and reveals a possible relation between this vaccine and viral reactivation. Since then, viral infections after vaccination have been reported. Vaccination against coronavirus disease 2019 (COVID‐19) has been launched by many countries.
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