Herpetic esophagitis in immunocompentent host: cases report

Abstract

Background: Herpetic esophagitis (EH) usually affects those who are immunocompromised and is uncommon in immunocompetent patients. In these cases, EH may occasionally present as an acute and self-limited illness. Such cases are rare and only a few have beenreported and limited published reviews exist making the benefits of antiviral therapy in immunocompetent patients unknown. Case presentation: We report four cases of young patients who presented dysphagia, odynophagia and epigastric pain. Endoscopic findings revealed lesions in the distal esophagus and histopathological changes compatible with herpes virus infection confirmed by viral DNA in every case. After treatment, every patient showed significant improvement and tolerated oral intake after discharge. Conclusions: In this publication, we present four immunocompetent patients with EH, without relevant alterations in laboratory workup and with negative HIV status. This disease is infrequent in patients with such characteristics and there are few cases published. In order to better understand this pathology, we present the symptoms, the endoscopic alterations and the clinical evolution with treatment. In our series, 50% of patients had serology compatible with acute HVS type 1 infection, 25% had a subacute infection pattern (IgM and IgG positive antibodies) and in another 25% of patients, serology was not done. No patient presented leukocyte alterations, while all patients presented with anatomopathological findings compatible with acute herpetic esophagitis and responded to acyclovir therapy.

Persistent Herpes Simplex Virus Type 1 Infection of Enteric Neurons Triggers CD8+ T Cell Response and Gastrointestinal Neuromuscular Dysfunction

“…Indeed, several research groups, including our own, have shown that HSV-1 can reach, infect, and persist in the neurons of the enteric nervous system (ENS) in rodents ( Gesser and Koo, 1996 ; Brun et al., 2010 ; Hill et al., 2012 ; Brun et al., 2018 ). In humans, HSV-1 is one of the most important causes of esophagitis in immunocompromised and immunocompetent hosts ( McDonald et al., 1985 ; Mosimann et al., 1994 ; Rodrigues et al., 2004 ; Bando et al., 2009 ; Canalejo et al., 2010 ; Diezma-Martín et al., 2020 ). Even if it is not possible to discriminate between reactivation and primary infections, during the past decade, evidence has suggested that the enteric nervous system can be a primary site of reactivation of neurotropic Herpes viruses ( Gesser and Koo, 1997 ; Gilden et al., 2001 ; Chen et al., 2011 ; Gershon et al., 2012 ).…”

Prolonged Intractable Hiccups Associated with HSV (I&II) Esophagitis and H. pylori Gastritis

“…There have been many cases of isolated H. pylori infections or HSV esophagitis, but the coexistence of both H. pylori and HSV is much rarer. Few cases were identified, one in which an immunocompetent adolescent had positive serology IgM and IgG for both HSV 1 and 2, with active esophageal ulcers and gastric inflammation consistent with H. pylori gastritis [ 8 ]. This case, however, presented with fever, odynophagia, and chest pain.…”

Herpes Simplex Virus Esophagitis in an Immunocompetent Patient

“…The most common symptoms are odynophagia, dysphagia, heartburn, epigastric pain, or chest pain. Concurrent oropharyngeal lesions are uncommon in immunocompetent hosts, but immunocompromised hosts usually have co-existent herpes labialis or oropharyngeal ulcers [ 1 , 8 , 9 ]. In our case, an immunocompetent male presented with generalized body aches, epigastric pain, nausea, vomiting, and odynophagia with no fever before or during hospitalization.…”