Atypical Herpes Esophagitis (original) (raw)
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Herpes Esophagitis in an Immunocompetent Teenager
Journal of Medical Cases, 2015
Herpes simplex virus (HSV) esophagitis is a rare infection in the immunocompromised host making it an even more rare condition in the immunocompetent population. Herpes esophagitis usually presents with the constellation of symptoms of odynophagia, dysphagia, fever and retrosternal chest pain. When immunocompetent patients present with odynophagia, the most common etiologies include pill induced esophagitis, toxic ingestion or severe reflux esophagitis. Rarely is infectious esophagitis from HSV, cytomegalovirus or candida considered. HSV is the most common cause of esophagitis typically from a reactivation of prior infection. In very rare cases does it present as a primary infection in the esophagus. We describe a case of HSV esophagitis in an 18-year-old immunocompetent host with no significant past medical history. He presented to his primary care physician with complaints of odynophagia and was prescribed a course of amoxicillin and prednisone syrup. He presented 4 days later to the emergency room with worsening odynophagia, retrosternal chest pain and anorexia. He was evaluated by the gastroenterology team and was taken for esophagogastroduodenoscopy (EGD), which revealed diffuse, bleeding, superficial ulcerations along the entirety of his esophagus. Biopsies were taken and subsequently found to be HSV positive. The patient was treated with intravenous acyclovir, a proton pump inhibitor and sucralfate suspension. HIV was tested and was found to be negative. No other causes of immunosuppression were found. We believe the patients' initial presentation was in fact a primary infection of HSV esophagitis, which was exacerbated by his oral prednisone use. The purpose of this report was to highlight the rare occurrence of infectious esophagitis with HSV possibly worsened by oral prednisone use in an otherwise healthy, young individual. Also, this report should raise awareness of clinicians to diagnose HSV esophagitis and begin prompt treatment on such patients. EGD with biopsy is the gold standard diagnostic modality for HSV esophagitis and should always be considered in young patients who present with odynophagia even in the absence of other alarm features. There is often a typical mucosal appearance with superficial, well-demarcated, small ulcerations along the mid to distal esophagus. The treatment of choice for HSV esophagitis is acyclovir 5 mg/kg every 8 hours for 7 -14 days. Symptoms for most immunocompetent patients resolve spontaneously in about 1 -2 weeks. In confirmed cases of HSV esophagitis, it is important to reassess the patient for any underlying immunodeficiencies. Although rare, HSV esophagitis should be entertained especially given the correct constellation of history and symptoms.
An Unusual Presentation of Herpes Esophagitis in an Immunocompromised Individual
Cureus, 2021
Herpes simplex infection remains the third most common cause of esophagitis following gastric reflux disease and candida infection. This disease usually occurs in immunocompromised individuals; however, it has been frequently reported in healthy individuals. We present a case of a 39-year-old man who presented to the ER with symptoms unusual of herpes esophagitis. He was presumed to be immunocompromised due to uncontrolled diabetes mellitus and chronic alcohol use. Endoscopy revealed features in favor of candidiasis; however, histopathology displayed characteristic features of herpes infection. Herpes esophagitis should thus be suspected in immunocompromised patients with an independent underlying pathology and treated early with antiviral agents like acyclovir to prevent impending complications.
Herpes Simplex Esophagitis in Immunocompetent Host: A Case Report
Diagnostic and Therapeutic Endoscopy, 2009
Introduction. Herpes simplex esophagitis is well recognized in immunosuppressed subjects, but it is infrequent in immunocompetent patients. We present a case of HSE in a 53-year-old healthy man. Materials and Methods. The patient was admitted with dysphagia, odynophagia, and retrosternal chest pain. An esophagogastroduodenoscopy revealed minute erosive area in distal esophagus and biopsies confirmed esophagitis and findings characteristic of Herpes Simplex Virus infection. Results. The patients was treated with high dose of protonpump inhibitor, sucralfate, and acyclovir, orally, with rapid resolution of symptoms. Discussion. HSV type I is the second most common cause of infectious esophagitis. The majority of symptomatic immunocompetent patients with HSE will present with an acute onset of esophagitis. Endoscopic biopsies from the ulcer edges should be obtained for both histopathology and viral culture. In immunocompetent host, HSE is generally a self-limited condition. Conclusions. HSE should be suspected in case of esophagitis without evident cause, even if the patient is immunocompetent. When the diagnosis of HSE is confirmed, careful history and assessment for an immune disorder such as HIV infection is crucial, to look for underlying immune deficiency.
Herpes simplex esophagitis in an immunocompetent host: a case report
Oxford Medical Case Reports
Esophagitis caused by Herpes Simplex virus is a well-recognized opportunistic infection in the immunocompromised or severely ill host. However, it is uncommon in otherwise immunocompetent host. It usually responds well to a course of acyclovir. We report a case of young female without any other immunocompromised state who presented with severe dysphagia. She was diagnosed endoscopically and later with histopathology and recovered well after a course of acyclovir.
Gastrointestinal Endoscopy, 2008
Epstein-Barr virus infectious mononucleosis can cause transient immune deficiency which may predispose to reactivation of latent herpes simplex virus (HSV) infection in the immunocompetent host. We report the case of a 15-year-old male who presented with severe odynophagia and herpes labialis during the course of Epstein-Barr virus infectious mononucleosis that had been diagnosed ten days before. Esophagoscopy revealed extensive ulcerations with distinct borders and whitish exudates at the mid and distal esophagus. Polymerase chain reaction detected HSV-1 DNA in the biopsy specimens. The patient was treated with intravenous acyclovir. The symptoms resolved rapidly within 3 days, in accordance with improved endoscopic findings. Fig. 2. Endoscopic image 3 days after acyclovir administration: depth and width of the lesions are significantly reduced and normal mucosa appears among the ulcerations.
Case Reports in Gastrointestinal Medicine, 2021
Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esophagitis (EoE) is characterized by immune-mediated eosinophil-predominant esophageal inflammation. We report a patient with human immunodeficiency virus infection who presented with dysphagia and odynophagia and was found to have HSE and EoE. The combination of these two relatively rare conditions suggests possible predisposition.
Herpetic esophagitis: a case report on an immunocompetent adolescent
Revista Española de Enfermedades Digestivas, 2012
Herpetic esophagitis in immunocompetent individuals is a rare entity that should be suspected clinically by an acute onset of symptoms, and without apparent cause of a symptomatic triad consisting on odynophagia, heartburn and fever.
Herpetic Esophagitis in Immunocompetent Host: Case Report
Acta Scientific Gastrointestinal Disorders, 2024
Introduction: Esophagitis is an entity mainly caused by noninfectious etiologies, most commonly gastroesophageal reflux disease. The majority of infectious cases are seen in immunocompromised patients and are mainly due to herpes simplex virus (HSV), cytomegalovirus (CMV) and Candida. Herpes simplex esophagitis has only been reported on few occasions in immunocompetent hosts. Case: We report a case of a young 28-year-old immunocompetent male presenting for agitation and hematemesis admitted to the hospital with eventual final diagnosis of herpetic esophagitis. Treatment with acyclovir resulted in good patient outcomes. Discussion and Conclusion: Herpes simplex esophagitis is common in immunocompromised patients but has only been reported on few occasions in immunocompetent hosts. Such a rare condition should be on the differential for any diffuse esophagitis of possible infectious etiology. Prompt diagnosis and treatment can lead to excellent outcomes in such patients.
Medicine, 2016
We aimed to investigate the clinical characteristics of patients with herpes esophagitis (HE) based on endoscopic typing.Herpes simplex virus infection in the gastrointestinal tract primarily affects the esophagus. However, little is known about the presentation, endoscopic findings, and outcomes of HE.From 2003 to 2013, 47 patients with HE were identified histologically from among 1843 patients with esophageal ulcers. Personal data, underlying disease, esophagogastroduodenoscopy indication, endoscopic characteristics, pathological findings, laboratory data, and outcomes were collected. Endoscopic findings were classified into 3 types based on gross appearance and were correlated with clinical presentation.The mean age of patients was 62.04 ± 14.76 years, and most patients were men (39/47, 83%). The most common symptoms were odynophagia/dysphagia (20/47, 42.6%). Whereas 25 patients (53.2%) were diagnosed with malignancy, it was related to human immunodeficiency virus in only 1 patie...