A rare cause of dysphagia: Herpes simplex esophagitis

Abstract

Herpes simplex esophagitis (HSE) is well documented in immunosuppressed patients. However, it is rare in the immunocompetent host. We present a case of HSE in a 21 year-old healthy lady who was admitted to our unit with dysphagia, odynophagia and chest pain. Clinical examination revealed mild epigastric tenderness and admission bloods including full blood picture, electrolytes and inflammatory markers were normal. She underwent an esophagogastroduodenoscopy (EGD) which revealed severe exudative, well-circumscribed ulcerations in her distal esophagus. Biopsies confirmed severe esophagitis with acute ulceration and subsequent polymerase chain reaction (PCR) confirmed herpes simplex virus (HSV) type 1. Subsequent assessment failed to identify an immune disorder. HSE should be suspected when faced with characteristic endoscopic findings, even if the patient is immunocompetent. When the diagnosis of HSE is confirmed, an immune deficiency should be sought.

A case report of herpetic and candidal esophagitis in an immunocompetent adult

“…Herpetic lesions of the esophagus are commonly seen as discrete ulcerations on an inflamed and friable mucosa at endoscopy mostly in the distal esophagus unlike in our patient where there was only desquamation with distal few centimeters of esophagus being spared [8,9,11] . In candidal esophagitis, the esophageal mucosa is typically friable and erythematous with ulcers covered by thick adherent white exudates [6,10] .…”

Virological Diagnosis of Herpes Simplex Virus 1 Esophagitis by Quantitative Real-Time PCR Assay

“…HSV-1 esophagitis diagnosis is based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions (10,11,12,14,19). The place of the virological diagnosis in an HSV-1 esophagitis diagnosis remains unclear.…”

“…HSV-1 esophagitis is well documented in immunocompromised patients, whereas this clinical entity is rare in immunocompetent patients (2,4,5,9). HSV-1 esophagitis may represent a primary infection in particular in the immunocompetent host but is commonly due to a reactivation of a latent infection in the immunocompromised host (7).Friable mucosa, numerous ulcers, and whitish exudates commonly involving the distal or the midesophagus are classical endoscopic aspects in HSV-1 esophagitis (10,11,14,19). These findings require confirmation by histological examination completed with immunohistochemical staining of the biopsy specimens from the ulcer edges, which still remains the "gold standard" for HSV-1 esophagitis diagnosis (13,14,19).…”

“…Friable mucosa, numerous ulcers, and whitish exudates commonly involving the distal or the midesophagus are classical endoscopic aspects in HSV-1 esophagitis (10,11,14,19). These findings require confirmation by histological examination completed with immunohistochemical staining of the biopsy specimens from the ulcer edges, which still remains the "gold standard" for HSV-1 esophagitis diagnosis (13,14,19).…”

“…These findings require confirmation by histological examination completed with immunohistochemical staining of the biopsy specimens from the ulcer edges, which still remains the "gold standard" for HSV-1 esophagitis diagnosis (13,14,19). Virological diagnosis has been reported to optimize the diagnostic sensitivity of HSV-1 esophagitis (2,16,19).…”