Eosinophilic esophagitis and herpes simplex esophagitis are separately well-described entities, but their simultaneous occurrence may pose a special challenge to the clinician, especially regarding the optimal therapeutic approach. The following case report describes a patient with a history of cow's milk and dairy products intolerance, but without an underlying immunologic defect, in whom eosinophilic esophagitis was diagnosed in the course of primary herpes simplex virus 1 (HSV1) infection that clinically presented as herpes labialis and severe esophagitis. The diagnosis was confirmed by a polymerase chain reaction from cytological brush and by immunohistochemical staining that detected the presence of HSV1 DNA in esophageal mucosa, and histologically by persistent eosinophil-predominant inflammation, typical of eosinophilic esophagitis. Despite severe clinical presentation, the HSV1 infection was self-limited. After a directed elimination diet was introduced, the clinical course was favorable, without the need for antiviral therapy.
Celiac disease (CD) and inflammatory bowel diseases (IBD) are separately well-described entities, but the co-occurrence in children has been very rarely reported until today. According to the literature, this case about 12-year-old girl would be the fifth case ever published about co-occurrence in children. We presume that there should be a higher comorbidity prevalence than that described. Distinguishing both diseases in one patient could be difficult due to the overlapping symptoms, but it is very important considering completely different therapeutic approaches.
total number of examinations performed was 1022. The most common indications for EGDS were: dyspepsia 32% (n =327), abdominal pain 21% (n= 211), and celiac disease 16% (n = 166). The most common endoscopic findings were : gastritis 50% (n =450), normal findings 35% (n = 325) and esophagitis 9% (n= 84). The most common PH findings were: normal 43% (n = 390), gastritis 23% (n=210), and duodenitis 15% (n =133). Of the total number of examinations, endoscopy was therapeutic in 10% (n= 98) of cases. The most common therapeutic indications were: foreign body ingestion 5% (n =51), PEG placement 3% (n= 35), and acid and alkali ingestion 1% (n=12).
ConclusionThe results obtainted are consistent with those of other studies and may indicate areas for additional education of staff and a starting point for future research on the topic.
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