Herpes Simplex Virus Duodenitis Accompanying Crohn's Disease

Abstract

Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastro-intestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.

Concomitant herpes simplex virus colitis and hepatitis in a man with ulcerative colitis

“…Interestingly, the vast majority of these cases have been in patients with HIV/AIDS or among solid organ and bone marrow transplant recipients, and not those with IBD—we found only 1 report of HSV duodenitis in a patient with Crohn's disease. [27] Involvement of other organs in IBD patients is even less common—to date only 2 cases of HSV meningoencephalitis [6,7] and a single case of HSV pneumonia/pneumonitis [5] have been reported, all in the setting of corticosteroid or anti-metabolite therapy.…”

Genetic Polymorphisms in Autophagy‐Associated Genes in Korean Children With Early‐Onset Crohn Disease

“…Although the results of our study were different from those of the Japanese in the association of IRGM SNPs with CD, the genetic similarity of the Korean population with CD to other eastern Asian populations with CD (especially the Japanese) is evident in some association studies. For instance, the associations of genetic variants in the NOD2 and ATG16L1 with CD were not replicated in Koreans (31,39), Japanese (32,41), and Han Chinese (42,43). In addition, TNFSF15 were associated with CD in Koreans (44) and Japanese (45,46).…”

“…Among the different SNPs, Arg702Trp, Gly908Arg, and leu1007fsinsC are well known as risk factors for the incidences of CD in Europe and North America (28–30). Korean (31), Japanese (32), and Indian (33) patients with CD, however, did not exhibit mutations in the NOD2 SNPs Arg702Trp, Gly908Arg, and leu1007fsinsC. It is unclear whether the reason for such discrepancy in results is because of the difference in ethnicity or in onset age.…”