A Severe Case of Disseminated Herpes Zoster in a Patient With Crohn's Disease on Upadacitinib Who Completed the Recombinant Zoster Vaccine Series

Herpes zoster (HZ) is caused by the reactivation of the varicella zoster virus and presents with painful vesicular lesions in a dermatomal distribution. Disseminated HZ occurs when skin lesions erupt in numerous dermatomes. Upadacitinib is the first oral medication approved to treat moderate-severe Crohn's disease and has been associated with nonsevere cases of HZ. We present a case of a 60-year-old woman with refractory Crohn's disease who failed multiple immunosuppressive therapies, completed the recombinant zoster vaccines, and developed disseminated HZ on high-dose upadacitinib. She was treated with intravenous acyclovir, upadacitinib was discontinued, and was discharged on suppressive valacyclovir.