Risk factors for herpes zoster in a cancer patient:
(1) no immunity (neither personal infection nor vaccination history)
(2) age >= 60 years (associated with waning immunity)
(3) corticosteroid, rituximab or other immunosuppressive therapy
(4) malignant lymphoma, leukemia or other disease associated with immunodeficiency
(5) organ, bone marrow or stem cell transplant
where:
• A patient may not recall a history of chickenpox or be able to ask a relative who would know. In these cases measuring antibody to zoster may be performed.
Manifestations:
(1) fulminant chickenpox in the nonimmune patient
(2) extensive shingles
(2a) trigeminal (CN V), especially the ophthalmic branch
(2b) Ramsay Hunt syndrome (CN VII and VIII, see previous section)
(3) severe postherpetic neuralgia
(4) encephalitis
