Herpes simplex virus esophagitis—clinical challenges in the elderly

Abstract

A 77-year-old woman presented with a 2-week history of malaise, prostration, anorexia, abdominal pain, vomiting and diarrhoea. She had been taking systemic corticosteroids for the past year. During hospitalisation, renal insufficiency, ionic changes and liver function abnormalities were detected and corrected. However, the patient developed total dysphagia. UGE revealed multiple shallow ulcers below the cricopharyngeal level and in the distal oesophagus, with normal-appearing intervening mucosa. Histological examination allowed the diagnosis of herpes simplex virus esophagitis. Treatment with intravenous acyclovir was instituted for 14 days. In the elderly, herpetic esophagitis may present with non-specific complains, such as prostration or anorexia. In the reported case, dysphagia was only detected as a late symptom, addressing the importance of maintaining a high degree of suspicion for the diagnosis of herpes simplex virus esophagitis.

Chronic Pain in the Elderly: Mechanisms and Perspectives

“…However, considering the long-lasting manifestations of PHN and the limited efficacy of the available pharmacological strategies, prevention strategies are likely the best strategy to be adopted ( John and Canaday, 2017 ; Gruver and Guthmiller, 2022 ). Extending the relevance of recognizing viral infections as a possible source of pain in elderly, a case report described the occurrence of abdominal pain combined with prostration appetite loss, vomiting and diarrhea in a 77-year-old woman with a diagnosis of herpes simplex virus esophagitis ( Custodio et al, 2021 ).…”

Case report of refractory esophageal ulcers caused by herpes simplex virus infection

“…But in immunocompetent individuals, treatment remains controversial, as the disease is considered self-limiting and spontaneous resolution usually occurs after 1-2 weeks. 16 To our knowledge, this is the longest-lasting HSE in an immunocompetent patient for about 10 months. The ulcers were refractory and persistent, which led to occult GI bleeding and severe IDA.…”