title: Severe perianal shingles during azathioprine and budesonide treatment for Crohn's disease-preventable with zoster vaccine?
abstract: Patients with inflammatory bowel disease (IBD), particularly those on immunosuppressive medications, suffer a high incidence of, and worse clinical outcomes relating to, herpes zoster (HZ) reactivation. We report on the presentation and management of a patient with Crohn's disease who developed severe perianal HZ after starting azathioprine and oral budesonide treatment. The zoster vaccine may prevent such zoster reactivation in patients with IBD. The zoster vaccine is effective in decreasing the risk of HZ in older adults but its role in younger adults and those with IBD has not been tested prospectively. A review of the potential risks and benefits of this live vaccine in patients with IBD and an approach to further determining its role in this patient population is discussed.
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia Department of Colorectal Medicine and Genetics, Melbourne Health, Parkville, Victoria, Australia.
authors.forename: Timothy Ross
authors.initials: TR
authors.lastname: Elliott
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Miller
authors.affiliation: Department of Colorectal Medicine and Genetics, Melbourne Health, Parkville, Victoria, Australia.
authors.forename: Finlay A
authors.initials: FA
authors.lastname: Macrae
mesh_terms: D000328:Adult; D000818:Animals; D001379:Azathioprine / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy*; D005938:Glucocorticoids / Q000627:therapeutic use; D006562:Herpes Zoster / Q000150:complications* / Q000473:pathology; D053061:Herpes Zoster Vaccine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010481:Perianal Glands / Q000473:pathology*
chemical_list: D005938:Glucocorticoids; D053061:Herpes Zoster Vaccine; D007166:Immunosuppressive Agents; D019819:Budesonide; D001379:Azathioprine