Candidate for a live vaccine

Immune dysfunction is a well-known phenomenon in end-stage liver disease (ESLD). The pretransplant period offers a unique window for primary care physicians to optimize the transplant's vaccine protection before antirejection medications are initiated. Live vaccinations are selected cautiously but the varicella-zoster virus (VZV) vaccine, Zostavax, is recommended for pretransplant candidates. This case highlights an ESLD patient who developed disseminated cutaneous VZV within 30 days of vaccination.