Publication:

Neurological complications of herpes zoster in adult patients receiving Janus kinase inhibitors: a systematic review

Herpes zoster (HZ) is a recognized infectious adverse event among adult patients receiving Janus kinase (JAK) inhibitors. Although most cases are cutaneous, neurological complications such as post-herpetic neuralgia (PHN), meningitis, and encephalitis may cause substantial morbidity. This systematic review was conducted at the Dermatology and Venereology Department, Mangusada Regional Hospital, Badung, Bali, Indonesia. PubMed, Cochrane Library, and ScienceDirect were searched from 1 May to 15 May 2026 using terms related to HZ, neurological complications, and JAK inhibitors. Eligible studies included clinical trial safety analyses, observational studies, pharmacovigilance studies, and case reports. Seven studies were included and synthesized narratively because of clinical and methodological heterogeneity. Seven studies were included. Evidence consisted of one matched cohort study, one case report, three tofacitinib clinical safety analyses, one ruxolitinib cream safety analysis, and one pharmacovigilance study. Tofacitinib accounted for most systemic JAK inhibitor evidence. In ulcerative colitis studies, HZ occurred in 5.6-8.2% of tofacitinib-treated patients, with PHN reported in 0.3% and one case of HZ encephalitis/meningitis. In rheumatoid arthritis, PHN occurred after first HZ events in 6.9% of patients. A case report described severe HZ meningitis after tofacitinib, with residual visual loss and facial nerve paralysis. Ruxolitinib cream was associated with rare HZ and isolated PHN. Pharmacovigilance data detected PHN signals for tofacitinib, ruxolitinib, and baricitinib. Clinicians should anticipate HZ risk during JAK inhibitor therapy and promptly evaluate neurological symptoms.