Herpes simplex esophagitis in the immunocompetent host

Abstract

We report here a case of herpes esophagitis with Mallory-Weiss syndrome in an immunocompetent host. A 26-year-old man was admitted to our hospital because of common cold symptoms and eruptions on the body. On day 2 after hospitalization, the patient showed high-grade fever, odynophagia and hematemesis. Upper gastrointestinal endoscopic examination showed multiple ulcerations throughout the mid- and distal esophagus. Bleeding from a Mallory-Weiss tear was also seen. Follow-up endoscopic examinations showed whitish exudates on day 5. Histological examination of biopsy specimens showed Cowdry type A intranuclear inclusion bodies in epithelial cells. Positive staining of a specific antibody against herpes simplex virus-1 (HSV-1) was seen in the nuclei of esophageal epithelial cells. Primary HSV-1 infection was suspected because ELISA titers of serum IgM antibody against HSV-1 were high and titers of serum IgG antibody against HSV-1 increased from an almost cut-off ratio. A diagnosis of herpes esophagitis in an immunocompetent host was made. Our case is the first report of herpes esophagitis with Mallory-Weiss syndrome in the immunocompetent host. It is important to remind herpes esophagitis in cases of severe odynophagia even in immunocompetent hosts.

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

“…Histologic demonstration of intranuclear inclusions in epithelial cells or multinucleated giant cells with groundglass-appearing nuclei is occasionally found in the biopsies of patients with herpetic esophagitis [12] . To confirm the presence of invasive candidal esophagitis, Candida spp.…”

Herpetic esophagitis: a case report on an immunocompetent adolescent

“…In the remaining 2% the stomach is involved concurrently (10). Possible complications of esophageal involvement are rare but severe: upper gastrointestinal bleeding (5.3%) (3,9,10) and esophageal perforation (1.8%) (9,12).…”

“…Histology is characterized by the presence of multinucleated giant cells with eosinophilic intranuclear inclusions called Cowdry type A inclusions (3,9). Another supplementary diagnostic method is serology testing, which allows in some cases to determine the primary infection detected after seroconversion.…”

“…Prodromal symptoms are often nonspecific and associated with malaise. Sometimes orolabial herpetic lesions are observed at the same time (3,4).…”

“…The initial clinical suspicion allows for a prompt diagnosis and the establishment of the correct therapeutic measures to prevent an insidious course of the disease and its complications (2,3).…”