Total dysphagia after short course of systemic corticotherapy: Herpes simplex virus esophagitis

Abstract

A 72 year-old female developed a herpetic esophagitis after 3 d of oral corticotherapy for an acute exacerbation of chronic obstructive pulmonary disease, presenting as odynophagia and total dysphagia. Biopsies were taken during a first esophagogastroduodenoscopy (EGD) and the patient was referred to the thoracic surgery service with a presumptive diagnosis of esophageal cancer. A second EGD was planned for dilatation, but by that time the stenosis was completely resolved. The biopsies taken during the first EGD revealed multiple herpetic viral inclusions and ulcerations without any dysplasia or neoplasia. In front of a severe esophageal stenosis, one must still exclude the usual differential diagnosis peptic stenosis and cancer. Visualization of endoscopic lesions can suggest the diagnosis but must be promptly confirmed by biopsy, viral culture or polymerase chain reaction. Although immune systemic effects of corticotherapy are well known and herpetic esophagitis occurs most frequently in immunocompromised individuals, this case emphasizes the importance of clinical awareness concerning short courses of corticotherapy for immunocompetent individuals. This article discusses the reactivation process of herpetic infection in this context and addresses its diagnostic and therapeutic issues.

Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

“…Reactivation of herpetic infection with the spread of the virus to the esophagus by direct extension from the oral cavity can appear following a course of low dose corticotherapy and can induce HSV esophagitis. Few case reports of HSV reactivation associated with corticotherapy have been published [18]. In our data, as well as in the majority of cases reported, HSV-induced esophagitis occurred in the absence of corticotherapy.…”

“…HSV-induced esophagitis is a severe infection that occasionally appears in immunocompetent hosts [16][17][18]. All of our patients with HSV-induced esophagitis were immunocompromised.…”

Herpetic esophagitis: An uncommon cause of dysphagia

“…[6] Acyclovir is the drug of choice, and it is to be given in the dosage of 5 mg/kg for 7-14 days. [7] In a patient with short duration of clinical history of dysphagia and characteristic endoscopic finding, CMV esophagitis should be suspected irrespective of immune status.…”

Herpetic esophagitis following bendamustine-containing regimen

“…Usually, the main complaints of HE are reported as fever and appetite loss, with retrosternal chest pain due to esophageal stenosis secondary to mucosal edema, especially in cases of immunodeficiency. 3 , 9 , 10 Although there were no stenotic lesions or edematous mucosa detected in the patient’s esophagus, her symptoms were relieved after treatment with valacyclovir. Thus, we suspected that HE was one of the causes of her gastrointestinal discomfort.…”