Gray-scale and color or power Doppler sonography can show changes in disease activity in children and young adults undergoing treatment for inflammatory bowel disease.
Herpes Simplex Virus and Eosinophilic EsophagitisA previously healthy 4-year-old boy presented with acute onset of odynophagia. His esophagogastroduodenoscopy revealed erosive esophagitis with exudate throughout the esophagus (Fig. 1). Histopathology revealed several cells with enlarged nuclei and geometric glassy intranuclear inclusions consistent with herpes simplex virus (HSV) (Fig. 2A). There were acute inflammatory cells but no eosinophils. Immunostain for HSV 1-2 cocktail showed a strong positivity in the infected epithelial cells (Fig. 2B). The patient responded well to acyclovir. He was maintained on a proton pump inhibitor during the entire follow-up period.Esophagogastroduodenoscopies were repeated at 6 and 18 weeks after the initial endoscopy. Biopsies on both occasions showed persistent eosinophilia in the mid and distal esophagus (>50 eosinophils/high-power field).HSV and eosinophilic esophagitis (EoE) have been reported (1). It has been suggested that mucosal trauma can make the esophagus more susceptible to HSV infection (2). Preexisting EoE may explain the severe esophagitis with HSV in this immunocompetant patient; however, he had no eosinophils on the initial biopsies. It is possible that EoE developed subsequent to the HSV esophagitis. Infections resulting in mucosal breaks could serve as portals to sensitize the host against known antigenic stimuli like food and aeroallergens (3).
The authors present a clinical case of a patient with mild liver disease and coagulopathy. The diagnosis was reached through careful histologic examination of liver biopsy. Electron microscopy played an important role in confirming the diagnosis.
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