Intractable hiccups due to herpetic esophagitis in an immunocompromised patient

Abstract

IntroductionHerpes virus family's association with visceral lesions is well established. Herpes simplex virus presentations vary based on immune status. Intractable hiccups due to herpes simplex esophagitis, to the best of our knowledge have been described twice in the literature. We present a 68 year-old immunocompromised male with intractable hiccups for 10 months.Case68 year-old male with end-stage renal disease and multiple myeloma presented with coffee ground emesis and hiccups of ten months duration. A year earlier, he received cycles of bortezomib and dexamethasone, remaining on lenalidomide. During chemotherapy, he developed pneumococcal meningitis and subsequently intractable hiccups. Preceding admission, endoscopy showed duodenitis and esophagitis. Proton-pump inhibitor therapy was initiated; however, biopsy was not performed.During admission, hiccups often occurred every few seconds while off anti-emetics, persisting despite therapy. Exam showed cachexia/temporal wasting, aphthous stomatitis and abdominal tenderness. MRI of brain/spine, CT of neck, chest, abdomen and neurological evaluation were unremarkable. Endoscopy revealed gastritis and esophagitis with mucosal tears. Biopsy revealed intra-nuclear inclusions with multi-nucleated cells, consistent with herpes virus, later confirmed as herpes simplex by immunostaining. Hiccups and emesis resolved after of 2 days of intravenous acyclovir. 21 days of treatment were completed with oral valacyclovir. He remained free of hiccups during the remaining hospital stay and follow up.This case illustrates an exceptionally rare presentation of herpetic esophagitis in an immunocompromised host. As novel immunotherapeutic/suppressive agents continue to emerge, the evolving role of herpes virus prophylaxis and diagnosis of atypical presentations in new host populations is a topic of growing importance.

A Case Of Multiple Myeloma With Triple Herpes Virus Infections

“…5 Another case of 68-year African-American male with multiple myeloma was reported by Harris et al who developed pneumococcal meningitis along with HSV esophagitis after nine cycles of bortezomib and dexamethasone. 6 Here, we have reported a case of multiple myeloma who developed co-infection with three members of herpesviridae family during the first cycle of chemotherapy. To the authors' knowledge, no such case of multiple myeloma with CMV, EBV and HSV co-infection has been reported in literature.…”

Gingivostomatitis Herpetica Acuta in Primary Infection with Human Herpes Virus

“…Medzi nežiadúce účinky možno zaradiť nauzeu, zvracanie, hnačky, prípadne bolesti brucha. Niekedy sa môže objaviť anemický syndróm [6]. Z neurologických príznakov boli pozorované bolesti hlavy a závrate, halucinácie a kŕče.…”

Rare Etiology of Odynophagia in a Female Adolescent

“…They are transmitted after contact with infectious secretions that contain either HSV-1 (commonly detected in oral secretions) or HSV-2 (usually found in genital secretions). HSV-1 in the gastrointestinal tract frequently induces orofacial and esophageal herpetic lesions, and HSV-2 often causes perianal and rectal herpetic lesions [ 1 ]. The esophagus is commonly involved in patients with AIDS or an underlying malignancy, those receiving immunosuppressive therapy and, finally, terminally ill patients who underwent nasogastric intubation.…”

“…The esophagus is commonly involved in patients with AIDS or an underlying malignancy, those receiving immunosuppressive therapy and, finally, terminally ill patients who underwent nasogastric intubation. Further, it is attributed usually to virus reactivation and rarely to primary infection [ 1 ].…”

“…The most common clinical features of herpes esophagitis (HE) are dysphagia, odynophagia, chest pain, and fever. Although the disease is usually self-limiting, severe complications, such as upper gastrointestinal hemorrhage and esophageal rupture, may be observed [ 1 , 2 ]. On endoscopy, HE can appear as discrete or continuous ulcers with superficial or deep appearance with or without overlying exudates or, even rarely, as necrotic changes in the mucosa in the middle and distal esophagus [ 3 ].…”