esophageal dilation is a safe procedure. Nonadherence to the "rule of 3" does not appear to be associated with a higher risk of complications, including esophageal perforation.

Herpetic esophagitis (HE) and eosinophilic esophagitis (EE) are both conditions that may in themselves represent a cause for dysphagia in young males. Their association has been suggested in the literature, but remains controversial (1). Case reportA 17yearold male presented with retrosternal pain, dyspha gia, and fever at 39 °C. Oral endoscopy revealed deep longi tudinal erosions with irregular, elevated borders from the mid to distal esophagus (Fig. 1A). He was prescribed acyclovir for suspected HE, which was later histologically confirmed. Fur thermore, the eosinophil count in the proximal esophagus was > 15 per field, consistent with EE. Followup endoscopy at one month after treatment revealed persistent endoscopic and histo logic signs suggestive of EE (Fig. 1B) in the absence of HSVI.A 36yearold male with a history of asthma, who was not taking bronchodilators, corticoids or antibiotics, presented with acute dysphagia of three days duration. Oral endoscopy revealed a longitudinal, ulcerated, subcentimetric cardial lesion, which a pathological analysis showed that it included Cowdry A inclu sions suggestive of HE. Histologically, there was esophageal candidiasis and EE comorbidity. At eight weeks after treatment with fluconazole, acyclovir, and pantoprazole changes suggestive of infectious esophagitis had cleared, whereas those consistent with EE persisted.The immunological study was normal for both patients. DiscussionTwo theories have been postulated with regard to the associa tion of EE and HE. The first one suggests that EE predisposes to altered Th2 responses, thus inducing dysfunction in the mucosal barrier, which facilitates viral infection. The second theory sup ports that HE acts as a sensitizing antigen to increase the immune response, which results in hyper reactivity and eosinophilic infil tration of the esophageal mucosa (2,3). Hence, HE and EE may seemingly act as predisposing factors for each other.