The coexistence of thromboembolism and herpes zoster (HZ) has emerged as a critical area of investigation due to the significant vascular complications associated with varicella-zoster virus (VZV) reactivation. HZ, resulting from VZV reactivation, affects approximately 20%‒30% of individuals with latent infection. From the first clinical observations of stroke (CVA) after HZ to large epidemiological studies demonstrating increased risks of cerebrovascular and cardiac events post-HZ, VZV reactivation induces vascular inflammation and thrombosis, with epidemiological evidence linking HZ to thromboembolic events. To date, there are few reports in the literature evidencing this association. This case report describes an older female patient with multiple risk factors, highlighting the uncommon concomitant presentation of pulmonary thromboembolism and herpes zoster. An 82-year-old female patient, hypertensive, dyslipidemic, with dementia and hypothyroidism, was admitted with dyspnea for five days and the appearance of painful vesicular lesions on the right lower limb, with progressive worsening. Laboratory tests revealed hemoglobin 11.7 g/dL, leukocytes 8,330/µL, elevated Pro-BNP to 14,600 pg/mL, and D-dimer 11.65 ng/dL. Doppler ultrasound of the lower limbs was performed, and anticoagulation was started due to suspicion of pulmonary thromboembolism (PTE), confirmed by CT angiography, showing bilateral subsegmental thromboembolism. Acyclovir was also started for seven days due to the diagnosis of herpes zoster. After these measures, the patient showed improvement in dyspnea, with progressive weaning from oxygen therapy, and resolution of the lesions on the right thigh. She was discharged for outpatient follow-up. The coexistence of pulmonary thromboembolism and herpes zoster, as observed in this case, is a finding with few direct reports in the scientific literature. The association of herpesviruses with thrombotic events is a complex research topic and, although not widely documented for PTE and herpes zoster specifically, some authors have already reported a link between herpes zoster and deep vein thrombosis, suggesting that the inflammatory mechanism and virus-induced endothelial dysfunction may favor a hypercoagulable state. Additionally, there are few descriptions of HZ with pulmonary thromboembolism, underscoring the importance of considering atypical manifestations in HZ.
Gonçalves et al. (2026) studied this question.