{
  "abstract": "Objectives Anifrolumab is increasingly becoming an important therapeutic option for systemic lupus erythematosus (SLE), but evidence points to a heightened risk of varicella-zoster virus (VZV) reactivation.We aim to describe the cases of VZV reactivation in patients with SLE treated with anifrolumab at our center.Methods Clinical data of SLE patients treated with anifrolumab were retrospectively collected and reviewed.Results Among nine SLE patients receiving anifrolumab, two(22.2%) experienced VZV reactivation.Case 1: A 39-year-old woman with SLE presenting joint and mucocutaneous involvement. Hydroxychloroquine and prednisolone led to a significant improvement of articular symptoms, but extensive cutaneous involvement persisted (CLASI-A25). Due to severe lymphopenia secondary to azathioprine and mycophenolate mofetil, anifrolumab was initiated. The patient showed marked improvement of cutaneous lesions and alopecia (CLASI-A7). After 19 months, she developed painful erythematous and vesicular lesions along the left T10 dermatome, consistent with shingles. She was treated with oral valaciclovir, with complete resolution.Case 2: A 38-year-old woman with SLE presenting joint, hematologic and cutaneous involvement. She had gastrointestinal intolerance to hydroxychloroquine and methotrexate. Due to therapeutic failure with rituximab, she was switched to anifrolumab. Twelve days after the first infusion, she developed a painful vesicular rash over the left T8-T9 dermatomes, suggestive of shingles. She was treated with oral valaciclovir, but without improvement. Given signs of bacterial co-infection, she was hospitalized for intravenous antibiotics, with a favourable outcome. However, she subsequently developed postherpetic neuralgia requiring daily gabapentin.Both patients had a history of childhood varicella infection but had not received VZV vaccination due to financial constraints.Conclusions The risk of VZV reactivation is 2.5times higher in patients with SLE than in the general population and is especially pronounced in immunosuppressed patients with anti–IFNalpha antibodies. Anifrolumab further increases this risk, and in our observation, VZV reactivation can occur shortly after treatment initiation.In our three-year clinical experience, two cases of shingles (22.2%) occurred among nine patients treated with anifrolumab. Although shingles can often be managed in primary care, patients treated with anifrolumab may be more susceptible to serious infection and complications. Our findings emphasize the importance of ensuring VZV vaccination and the necessity to improve its accessibility.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Bárbara Fernandes Esteves"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Miguel Correia Natal"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Bruno Miguel Fernandes"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Maria Seabra Rato"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Salomé Garcia"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Lúcia Costa"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS de São João, Porto, Portugal"
      ],
      "name": "Raquel Miriam Ferreira"
    }
  ],
  "title": "PO:03:080 Varicella-zoster virus reactivation in systemic lupus erythematosus patients treated with anifrolumab: single-center experience",
  "uid": "8bb95a22-5d10-5c18-9c41-92706e20975a"
}