Introduction

Herpes zoster (HZ) results from reactivation of latent varicella zoster virus (VZV) within dorsal root ganglia and is associated with well-established risk factors, including increasing age and impaired cell-mediated immunity.1 Although systemic corticosteroids impair T-cell–mediated antiviral responses and increase the risk of HZ,2,3 the role of localized corticosteroid administration, particularly intra-articular injection, remains less well defined and appears to be uncommon.4,5

Rarely, herpes zoster may rarely manifest as cutaneous small-vessel vasculitis, which is most frequently reported in immunocompromised individuals.6,7 Fewer than a dozen cases of HZ-associated leukocytoclastic vasculitis have been described in the literature, and reports involving immunocompetent patients are exceedingly limited. To our knowledge, no prior reports have described the coexistence of HZ-associated cutaneous vasculitis following intra-articular corticosteroid injection in an immunocompetent patient.

Here, we present such a case and discuss potential mechanisms linking localized corticosteroid administration, viral reactivation, and vascular inflammation.