Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1990 Aug;49(8):630–633. doi: 10.1136/ard.49.8.630

High incidence of herpes zoster in patients with systemic lupus erythematosus: an immunological analysis.

K Nagasawa 1, Y Yamauchi 1, Y Tada 1, T Kusaba 1, Y Niho 1, H Yoshikawa 1
PMCID: PMC1004180  PMID: 2168693

Abstract

The incidence of herpes zoster was determined in patients with systemic lupus erythematosus (SLE) and the cellular and humoral immunity to varicella zoster virus (VZV) investigated in 45 of these 92 patients. The incidence of herpes zoster was high, occurring in 40 patients (43%), though it was benign in all. Patients with SLE who had had zoster showed significantly higher antibody titres than normal subjects. On the other hand, only 13 of 43 (30%) patients with SLE showed positive delayed hypersensitivity skin reactions to VZV antigen, despite a history of infections with VZV, whereas all 15 normal subjects had positive reactions. Skin reactions to VZV correlated directly with the ratio of OKT4+ to OKT8+ T cells and inversely with the dose of corticosteroids. These results suggest that the high incidence of herpes zoster in patients with SLE is probably due to defects in cellular immunity and that normal or higher titres of antibodies to VZV will not act as a preventive against zoster. In addition, reactivation of VZV, whether symptomatic or not, seemed often to occur in patients with SLE.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arvin A. M., Pollard R. B., Rasmussen L. E., Merigan T. C. Cellular and humoral immunity in the pathogenesis of recurrent herpes viral infections in patients with lymphoma. J Clin Invest. 1980 Apr;65(4):869–878. doi: 10.1172/JCI109739. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BURGOON C. F., Jr, BURGOON J. S., BALDRIDGE G. D. The natural history of herpes zoster. J Am Med Assoc. 1957 May 18;164(3):265–269. doi: 10.1001/jama.1957.02980030041010. [DOI] [PubMed] [Google Scholar]
  3. Baba K., Yabuuchi H., Okuni H., Takahashi M. Studies with live varicella vaccine and inactivated skin test antigen: protective effect of the vaccine and clinical application of the skin test. Pediatrics. 1978 Apr;61(4):550–555. [PubMed] [Google Scholar]
  4. Bakke A. C., Kirkland P. A., Kitridou R. C., Quismorio F. P., Jr, Rea T., Ehresmann G. R., Horwitz D. A. T lymphocyte subsets in systemic lupus erythematosus. Correlations with corticosteroid therapy and disease activity. Arthritis Rheum. 1983 Jun;26(6):745–750. doi: 10.1002/art.1780260607. [DOI] [PubMed] [Google Scholar]
  5. Burke B. L., Steele R. W., Beard O. W., Wood J. S., Cain T. D., Marmer D. J. Immune responses to varicella-zoster in the aged. Arch Intern Med. 1982 Feb;142(2):291–293. [PubMed] [Google Scholar]
  6. Cupps T. R., Edgar L. C., Thomas C. A., Fauci A. S. Multiple mechanisms of B cell immunoregulation in man after administration of in vivo corticosteroids. J Immunol. 1984 Jan;132(1):170–175. [PubMed] [Google Scholar]
  7. DUBOIS E. L., TUFFANELLI D. L. CLINICAL MANIFESTATIONS OF SYSTEMIC LUPUS ERYTHEMATOSUS. COMPUTER ANALYSIS OF 520 CASES. JAMA. 1964 Oct 12;190:104–111. doi: 10.1001/jama.1964.03070150014003. [DOI] [PubMed] [Google Scholar]
  8. Dolin R., Reichman R. C., Mazur M. H., Whitley R. J. NIH conference. Herpes zoster-varicella infections in immunosuppressed patients. Ann Intern Med. 1978 Sep;89(3):375–388. doi: 10.7326/0003-4819-89-3-375. [DOI] [PubMed] [Google Scholar]
  9. Fauci A. S., Dale D. C., Balow J. E. Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med. 1976 Mar;84(3):304–315. doi: 10.7326/0003-4819-84-3-304. [DOI] [PubMed] [Google Scholar]
  10. Gershon A. A., Steinberg S. P. Cellular and humoral immune responses to varicella-zoster virus in immunocompromised patients during and after varicella-zoster infections. Infect Immun. 1979 Jul;25(1):170–174. doi: 10.1128/iai.25.1.170-174.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ginzler E., Diamond H., Kaplan D., Weiner M., Schlesinger M., Seleznick M. Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis Rheum. 1978 Jan-Feb;21(1):37–44. doi: 10.1002/art.1780210107. [DOI] [PubMed] [Google Scholar]
  12. HOPE-SIMPSON R. E. THE NATURE OF HERPES ZOSTER: A LONG-TERM STUDY AND A NEW HYPOTHESIS. Proc R Soc Med. 1965 Jan;58:9–20. [PMC free article] [PubMed] [Google Scholar]
  13. Hahn B. H., Bagby K. K., Osterland C. K. Abnormalities of delayed hypersensitivity in systemic lupus erythematosus. Am J Med. 1973 Jul;55(1):25–31. doi: 10.1016/0002-9343(73)90146-0. [DOI] [PubMed] [Google Scholar]
  14. Hamaguchi T., Kotani Y., Imanaka S., Morito S., Kawamura Y. Lupus erythematosus and herpes zoster. Mie Med J. 1970 Jan;19(3):189–192. [PubMed] [Google Scholar]
  15. Horwitz D. A. Impaired delayed hypersensitivity in systemic lupus erythematosus. Arthritis Rheum. 1972 Jul-Aug;15(4):353–359. doi: 10.1002/art.1780150406. [DOI] [PubMed] [Google Scholar]
  16. Hurd E. R., Dowdle W., Casey H., Ziff M. Virus antibody levels in systemic lupus erythematosus. Arthritis Rheum. 1972 May-Jun;15(3):267–274. doi: 10.1002/art.1780150308. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kamiya H., Ihara T., Hattori A., Iwasa T., Sakurai M., Izawa T., Yamada A., Takahashi M. Diagnostic skin test reactions with varicella virus antigen and clinical application of the test. J Infect Dis. 1977 Dec;136(6):784–788. doi: 10.1093/infdis/136.6.784. [DOI] [PubMed] [Google Scholar]
  18. Mazur M. H., Whitley R. J., Dolin R. Serum antibody levels as risk factors in the dissemination of herpes zoster. Arch Intern Med. 1979 Dec;139(12):1341–1345. [PubMed] [Google Scholar]
  19. Miller A. E. Selective decline in cellular immune response to varicella-zoster in the elderly. Neurology. 1980 Jun;30(6):582–587. doi: 10.1212/wnl.30.6.582. [DOI] [PubMed] [Google Scholar]
  20. Moutsopoulos H. M., Gallagher J. D., Decker J. L., Steinberg A. D. Herpes zoster in patients with systemic lupus erythematosus. Arthritis Rheum. 1978 Sep-Oct;21(7):798–802. doi: 10.1002/art.1780210710. [DOI] [PubMed] [Google Scholar]
  21. Nagafuchi S., Iwahashi T., Higa K., Kusaba T., Dan K., Mori R. Delayed type hypersensitivity (DTH) skin reaction to varicella-zoster virus antigen in patients with systemic lupus erythematosus (SLE). Fukuoka Igaku Zasshi. 1988 Apr;79(4):311–313. [PubMed] [Google Scholar]
  22. Ragozzino M. W., Melton L. J., 3rd, Kurland L. T., Chu C. P., Perry H. O. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982 Sep;61(5):310–316. doi: 10.1097/00005792-198209000-00003. [DOI] [PubMed] [Google Scholar]
  23. Rosenthal C. J., Franklin E. C. Depression of cellular-mediated immunity in systemic lupus erythematosus. relation to disease activity. Arthritis Rheum. 1975 May-Jun;18(3):207–217. doi: 10.1002/art.1780180303. [DOI] [PubMed] [Google Scholar]
  24. SEVER J. L. Application of a microtechnique to viral serological investigations. J Immunol. 1962 Mar;88:320–329. [PubMed] [Google Scholar]
  25. Scheynius A., Klareskog L., Forsum U. In situ identification of T lymphocyte subsets and HLA-DR expressing cells in the human skin tuberculin reaction. Clin Exp Immunol. 1982 Aug;49(2):325–330. [PMC free article] [PubMed] [Google Scholar]
  26. Smolen J. S., Chused T. M., Leiserson W. M., Reeves J. P., Alling D., Steinberg A. D. Heterogeneity of immunoregulatory T-cell subsets in systemic lupus erythematosus. Correlation with clinical features. Am J Med. 1982 May;72(5):783–790. doi: 10.1016/0002-9343(82)90544-7. [DOI] [PubMed] [Google Scholar]
  27. Tan E. M., Cohen A. S., Fries J. F., Masi A. T., McShane D. J., Rothfield N. F., Schaller J. G., Talal N., Winchester R. J. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982 Nov;25(11):1271–1277. doi: 10.1002/art.1780251101. [DOI] [PubMed] [Google Scholar]
  28. Unanue E. R. The regulatory role of macrophages in antigenic stimulation. Part Two: symbiotic relationship between lymphocytes and macrophages. Adv Immunol. 1981;31:1–136. doi: 10.1016/s0065-2776(08)60919-0. [DOI] [PubMed] [Google Scholar]
  29. Vachtenheim J., Grossmann J. Choroby wirusowe opryszczkowe a układowy toczeń rumieniowaty. Pol Tyg Lek. 1965 Dec 6;20(49):1854–1856. [PubMed] [Google Scholar]
  30. WRIGHT E. T., WINER L. H. Herpes zoster and malignancy. Arch Dermatol. 1961 Aug;84:242–244. doi: 10.1001/archderm.1961.01580140068007. [DOI] [PubMed] [Google Scholar]
  31. Weller T. H. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. N Engl J Med. 1983 Dec 1;309(22):1362–1368. doi: 10.1056/NEJM198312013092205. [DOI] [PubMed] [Google Scholar]
  32. Weller T. H. Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. N Engl J Med. 1983 Dec 8;309(23):1434–1440. doi: 10.1056/NEJM198312083092306. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES