Herpes simplex primo‐infection in an immunocompetent host with eosinophilic esophagitis

Abstract

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.

Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis

“…Several case reports showing a coincidence of EoE and HSE have been published. 2 - 7 In our patients, the order of the 2 inflammatory events varied, but it is very likely that at least 4 of the 5 patients had active EoE at the onset of HSV infection, and were not under treatment before viral infection occurred. Though incidental, non-causative coexistence cannot be ruled out, based on the current knowledge, 3 hypotheses must been considered.…”

“…Recently, there have been isolated reports of EoE complicated by esophagitis from herpes simplex virus (HSV). 2 - 7 Herpes simplex esophagitis (HSE) is an infection occurring quite commonly in immunocompromised patients, mainly resulting from viral reactivation. 8 However, HSE rarely occurs in immunocompetent individuals.…”

Disease associations in eosinophilic oesophagitis and oesophageal eosinophilia

“…This association has been described in paediatric patients at the time of diagnosis [97,98] and, in contrast with common cases of HSV primary infection or reactivation, in EoE patients the infection appeared in immunocompetent individuals. This finding gives rise to the speculation that active inflammation of the oesophageal squamous epithelium may be a risk factor for acquiring HSV infections [99].…”

Environmental and infectious factors in eosinophilic esophagitis

“…In a similar case report, a 17 year old adolescent with concomitant atopy presented with signs of both herpes esophagitis and EoE at the initial endoscopy. (55) Subsequent biopsy showed increased eosinophils (34 eos/hpf) and the presence of HSV I. Follow-up at 2 and 3 months indicated resolution of HSV but persistent EoE.…”