Background: Systemic lupus erythematosus (SLE) is a prototypic chronic multisystem autoimmune disease that is highly heterogenous in its clinical manifestations and severity. Although SLE predominantly affects young women, children and adolescents contribute to 15–20% of this population [1]. Herpes zoster (HZ) is viral disease caused by reactivation of varicella-zoster virus which remains dormant in the sensory ganglia of the cranial nerve or the dorsal root ganglia after a previous varicella infection. There is limited information on the association of HZ and childhood-onset SLE (cSLE). This study aims to determine the risk factors of HZ infection (HZI) in patients diagnosed with cSLE at a tertiary hospital in the Philippines.

Objectives: To determine the risk factors of HZ infection in patients diagnosed with cSLE. To determine the demographic profile of patients diagnosed with cSLE. To compare the demographic profile, clinical features, laboratory data, treatment received, and outcome of HZ patients and non-HZ patients diagnosed with cSLE. To determine proportion of HZ patients diagnosed with cSLE.

Methods: This study is a single center retrospective cohort study which included all patients aged 18 years old and below at the time they were diagnosed with SLE between 2008 and 2023.

Results: A total of 388 patients were included in the study. The prevalence of herpes zoster was 15.72% (95% CI = 12.24% to 19.73%), with an incidence rate of 38.40 per 100 person-years (95% = 0.316 to 0.469). The median age at cSLE diagnosis was 13 years old (IQR = 11 – 16). Majority of the participants were females (92.78%) and had a median disease duration of 9 years (IQR = 5 – 12). The most common location of the HZ was the upper extremities (18.03%). The median Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at herpes zoster diagnosis was 4 (IQR = 0 – 12), 16.39% had recurrent HZI, 11.48% had superimposed bacterial infection, and more than two-thirds were treated with the anti-viral acyclovir or valacyclovir (88.52%). The proportion of participants with renal manifestations was significantly higher among those with herpes zoster infection (54.10% vs. 40.37%). Using multivariate analyses, glucocorticoid dosage ≥5mg (aRR=10.20, p =0.001), azathioprine (aRR=2.07, p =0.009), and intravenous cyclophosphamide (aRR=1.61, p =0.048) significantly predicted the likelihood of developed herpes zoster infection.

Conclusion: The prevalence and incidence of HZI in cSLE is 15.72% and 38.40 per 100 person-years, respectively. Risk factors identified for HZI among cSLE were lymphopenia, lupus nephritis, and immunosuppressive agents. In particular, IV cyclophosphamide, azathioprine, and glucocorticoid dose of ≥5mg increased the risk for development of HZI by 1.61, 2.07, 10.20 times, respectively.

REFERENCES: [1] Tang, S. P., Lim, S. C., & Arkachaisri, T. (2021). Childhood-Onset Systemic Lupus Erythematosus: Southeast Asian Perspectives. Journal of clinical medicine , 10 (4), 559. https://doi.org/10.3390/jcm10040559 .

[2] Zhao K, Xie H, Li L, Esdaile JM, Aviña-Zubieta JA. Increased risk of severe infections and mortality in patients with newly diagnosed systemic lupus erythematosus: a population-based study. Rheumatology . 2021; 60 (11):5300–5309. doi: 10.1093/rheumatology/keab219.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.