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Zoster Immunosuppression LN Review — ESENeph MCQ

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ModerateGlomerulonephritisZoster Immunosuppression LN ReviewESENeph

A 38-year-old woman with SLE and lupus nephritis Class III+V has completed induction and is on maintenance MPAA and Prednisolone. She develops herpes zoster (shingles) over two dermatomes. What does this suggest about her immunosuppressive state?

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Correct answer: C — Multi-dermatomal zoster indicates significant immunosuppression; consider whether immunosuppression can be reduced

Multi-dermatomal or disseminated herpes zoster in an immunosuppressed patient reflects impaired T-cell immunity. While antiviral treatment (Valaciclovir/Aciclovir) should be started immediately, the episode should prompt a review of the immunosuppression burden. If possible, Prednisolone should be tapered further. After recovery, the Shingrix vaccine (recombinant, non-live) should be considered for prevention of future episodes – it is safe in immunosuppressed patients.

Reference: NICE – Shingles Management; BSR 2019 – Vaccination in Immunosuppressed