1
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Hao Y, Cui Y, Chen YX, Sun DF. Case report of refractory esophageal ulcers caused by herpes simplex virus infection. J Dig Dis 2024; 25:209-211. [PMID: 38332647 DOI: 10.1111/1751-2980.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/13/2024] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Yu Hao
- NHC Key Laboratory of Digestive Diseases, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yun Cui
- NHC Key Laboratory of Digestive Diseases, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Xuan Chen
- NHC Key Laboratory of Digestive Diseases, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Feng Sun
- NHC Key Laboratory of Digestive Diseases, Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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2
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Moore E, Merali N, Abbassi-Ghadi N. Herpes simplex oesophagitis leading to perforation and mediastinal collection: a case report and review of literature. Ann R Coll Surg Engl 2023; 105:94-96. [PMID: 35639460 PMCID: PMC9773237 DOI: 10.1308/rcsann.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 12/24/2022] Open
Abstract
Herpes simplex oesophagitis is rare, especially in immunocompetent patients. A 78-year-old man presented with sepsis on the background of several months of retrosternal chest pain and fatigue. Computed tomography of the chest abdomen and pelvis revealed a large mediastinal collection and an oesophago-gastro-duodenoscopy demonstrated a healed mucosal scar from a spontaneously healed perforation. The collection was successfully drained with an ultrasound-guided drain and the patient made a full recovery. Spontaneous oesophageal perforation from herpes simplex oesophagitis has been reported five times in the literature, with only two occurrences in immunocompetent individuals.
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Affiliation(s)
- E Moore
- Royal Surrey NHS Foundation Trust, UK
| | - N Merali
- Royal Surrey NHS Foundation Trust, UK
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3
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Patel H, Nguyen SMT, Haque A, Krishnaswamy G. Odynophagia in a young adult: revisiting herpetic esophagitis and eosinophilic esophagitis. BMJ Case Rep 2022; 15:e251238. [PMID: 36368731 PMCID: PMC9660505 DOI: 10.1136/bcr-2022-251238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An immunocompetent man in his 20s presented with a 24-hour history of severe odynophagia, nausea, vomiting and throat pain. Esophagogastroduodenoscopy (EGD) revealed severe esophagitis with ulcerated mucosa, exudative debris, haemorrhage and multiple erosions. Biopsy of the oesophageal tissue demonstrated marginated chromatin, multinucleated giant cells and molding of nuclei, consistent with herpes simplex virus esophagitis (HSE). Treatment with oral acyclovir led to the complete resolution of symptoms. The patient subsequently developed dysphagia again, 8 months later. EGD showed furrowing and concentric rings typical of eosinophilic esophagitis (EoE), a diagnosis confirmed by biopsy. Treatment with a proton pump inhibitor and swallowed topical corticosteroids led to symptomatic improvement. Thus, HSE can occur in immunocompetent hosts and on occasion, HSE may be a harbinger of EoE, as evidenced by our extensive literature review. Mechanical disruption of the mucosal barrier by viruses, facilitating food allergen penetration, and associated immunological signaling abnormalities may be responsible phenomena requiring further elucidation.
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Affiliation(s)
- Hiral Patel
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Aaisha Haque
- Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA
| | - Guha Krishnaswamy
- Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA
- Department of Medicine, Section on Pulmonary, Critical Care, Allergy and Clinical Immunology, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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4
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Herpes simplex virus-2-associated esophagitis in immunocompetent host. PRZEGLAD GASTROENTEROLOGICZNY 2021; 16:248-251. [PMID: 34584588 PMCID: PMC8456770 DOI: 10.5114/pg.2020.100757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
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5
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Kataria R, D'Cruze L, Lal T, Senthil N, Sundaram S. An Unusual Presentation of Herpes Esophagitis in an Immunocompromised Individual. Cureus 2021; 13:e15635. [PMID: 34306847 PMCID: PMC8278358 DOI: 10.7759/cureus.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Herpes simplex infection remains the third most common cause of esophagitis following gastric reflux disease and candida infection. This disease usually occurs in immunocompromised individuals; however, it has been frequently reported in healthy individuals. We present a case of a 39-year-old man who presented to the ER with symptoms unusual of herpes esophagitis. He was presumed to be immunocompromised due to uncontrolled diabetes mellitus and chronic alcohol use. Endoscopy revealed features in favor of candidiasis; however, histopathology displayed characteristic features of herpes infection. Herpes esophagitis should thus be suspected in immunocompromised patients with an independent underlying pathology and treated early with antiviral agents like acyclovir to prevent impending complications.
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Affiliation(s)
- Riya Kataria
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Lawrence D'Cruze
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Tusharindra Lal
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - N Senthil
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sandhya Sundaram
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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6
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Custódio SF, Félix C, Cruz F, Veiga MZ. Herpes simplex virus esophagitis-clinical challenges in the elderly. BMJ Case Rep 2021; 14:14/4/e240956. [PMID: 33827878 PMCID: PMC8030671 DOI: 10.1136/bcr-2020-240956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- Sara Fernandes Custódio
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Catarina Félix
- Department of Gastroenterology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Fátima Cruz
- Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
| | - Manuela Zita Veiga
- Department of Internal Medicine, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
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7
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Bhoopalan SV, Alhosh R. Dysphagia and Epigastric Pain in an Adolescent Boy. Pediatr Rev 2021; 42:209-211. [PMID: 33795468 DOI: 10.1542/pir.2020-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Koutsoumourakis A, Gagalis A, Fotoulaki M, Stafylidou M. Rare Etiology of Odynophagia in a Female Adolescent. Case Rep Gastroenterol 2021; 15:352-358. [PMID: 33790725 PMCID: PMC7989787 DOI: 10.1159/000513801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022] Open
Abstract
Herpes esophagitis (HE) is a rare condition in immunocompetent adolescents. However, it commonly occurs as a primary infection in younger individuals. Herein, we report a 16-year-old female patient who had a history of fever for 5 days, odynophagia, and orolabial herpes infection for 7 days. Clusters of painful vesicles on an erythematous base on the lips, gingiva, and palate were observed on physical examination. Further, esophagogastroduodenoscopy revealed diffuse linear ulcerations in the distal esophagus. The patient then received the following treatment: intravenous (I.V.) acyclovir 5 mg/kg three times a day, I.V. omeprazole 40 mg two times a day, and acyclovir 5% cream four times a day. After 8 days of admission, the patient was discharged. A follow-up esophagogastroduodenoscopy was performed 7 weeks after discharge, and the results revealed that the esophageal mucosa had a normal appearance. The effect of antiviral treatment against HE remains unknown in these patients. Nevertheless, it is believed to accelerate the healing process in individuals with esophageal mucosal barrier damage. To the best of our knowledge, this case of a female adolescent with an intact immune system is the sixth case of herpes simplex esophagitis to be reported in the literature.
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Affiliation(s)
| | - Asterios Gagalis
- First Department of Internal Medicine, Papageorgiou Teaching Hospital, Thessaloniki, Greece
| | - Maria Fotoulaki
- Fourth Department of Pediatrics, Papageorgiou Teaching Hospital, Thessaloniki, Greece
| | - Maria Stafylidou
- First Department of Internal Medicine, Papageorgiou Teaching Hospital, Thessaloniki, Greece
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9
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Trukhmanov AS, Makushina AA, Storonova OA, Ivashkina NY. [Evaluation and management of infectious esophagitis in immunocompromised patients and immunocompetent individuals]. TERAPEVT ARKH 2020; 92:108-117. [PMID: 33346470 DOI: 10.26442/00403660.2020.08.000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 11/22/2022]
Abstract
Among the many causes of the inflammatory process in the esophagus, infectious diseases are becoming increasingly important due to their steady growth. Previously esophageal infections have traditionally been associated with immunodeficiency syndromes, but now in clinical practice, these disorders are becoming increasingly recognized in immunocompetent individuals. Early diagnosis of infectious esophagitis is necessary to develop effective treatment tactics, and, as a result, reduce the risk of complications and adverse outcomes of the disease. This study reviewed the most clinical relevant pathogens of infectious esophagitis, both among patients with immunodeficiency and among healthy individuals. Specific diagnostic, risk factors, clinical presentation and therapeutic features were considered depending on the immune status of patients.
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Affiliation(s)
- A S Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - A A Makushina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O A Storonova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - N Y Ivashkina
- Sechenov First Moscow State Medical University (Sechenov University)
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10
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A Creeping Malaise Leading to Calamity: Herpes Esophagitis Perforation. Ann Thorac Surg 2020; 109:e339-e341. [DOI: 10.1016/j.athoracsur.2019.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/25/2019] [Accepted: 08/31/2019] [Indexed: 11/20/2022]
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Bordea MA, Pîrvan A, Gheban D, Silaghi C, Lupan I, Samașca G, Pepelea L, Junie LM, Costache C. Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features. J Clin Med 2020; 9:jcm9040939. [PMID: 32235458 PMCID: PMC7230472 DOI: 10.3390/jcm9040939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of this study is to provide information about prevalence, etiology, risk factors, clinical characteristics and endoscopic features of various types of infectious esophagitis in children. METHODS We performed a total of 520 upper gastrointestinal tract endoscopies in Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca. Indications for endoscopy in our cohort were gastrointestinal tract symptoms such as dysphagia, heartburn, or appetite loss. RESULTS The prevalence of infectious esophagitis in the study population was 2.11% (11 patients). Candida albicans (C. albicans) was the most frequent cause. Our data illustrates that herpes simplex virus (HSV)-induced esophagitis is common in immunocompromised patients and should be systematically suspected in cases of severe dysphagia, heartburn, or hematemesis. In the present study, all cytomegalovirus (CMV) esophagitis patients were immunocompromised. Immunodeficiency (81.8%) and prolonged antibiotic therapy with broad-spectrum antibiotics were by far the most important risk factors involved in the pathogenicity of the disease. Dysphagia, appetite loss, heartburn, epigastralgia, and hematemesis were the main clinical manifestations. Infectious esophagitis was associated with significant mortality. In four patients, endoscopy during life showed signs of infectious esophagitis; however, the precise etiology was only established post-mortem, in the pathological anatomy laboratory department. A risk factor involved in pathogenesis of post-mortem diagnosed infectious esophagitis is the DiGeorge syndrome for CMV and HSV patients. CONCLUSIONS The study illustrates that infectious esophagitis should be considered in immunocompromised infants with prolonged antibiotic therapy with broad-spectrum antibiotics.
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Affiliation(s)
- Mădălina Adriana Bordea
- Department of Microbiology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania; (M.A.B.); (L.P.); (L.M.J.); (C.C.)
- Department of Pediatrics II, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Alexandru Pîrvan
- Department of Pediatrics II, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Dan Gheban
- Department of Pathology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Ciprian Silaghi
- Department of Biochemistry, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania;
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, 400151 Cluj-Napoca, Romania;
| | - Gabriel Samașca
- Department of Immunology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania
- Correspondence:
| | - Lia Pepelea
- Department of Microbiology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania; (M.A.B.); (L.P.); (L.M.J.); (C.C.)
| | - Lia Monica Junie
- Department of Microbiology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania; (M.A.B.); (L.P.); (L.M.J.); (C.C.)
| | - Carmen Costache
- Department of Microbiology, IuliuHatieganu University of Medicine and Pharmacy, 400151 Cluj-Napoca, Romania; (M.A.B.); (L.P.); (L.M.J.); (C.C.)
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12
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Narasimhalu T, Olson KA. Educational Case: Infectious Esophagitis. Acad Pathol 2020; 7:2374289520903438. [PMID: 32083170 PMCID: PMC7005969 DOI: 10.1177/2374289520903438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/15/2019] [Accepted: 01/01/2020] [Indexed: 11/28/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Tara Narasimhalu
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Kristin A Olson
- Pathology and Laboratory Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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13
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Hoversten P, Kamboj AK, Wu TT, Katzka DA. Variations in the Clinical Course of Patients with Herpes Simplex Virus Esophagitis Based on Immunocompetence and Presence of Underlying Esophageal Disease. Dig Dis Sci 2019; 64:1893-1900. [PMID: 30725296 DOI: 10.1007/s10620-019-05493-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Herpes simplex esophagitis (HSE) is the second most common cause of infectious esophagitis and occurs in both immunocompetent and immunocompromised patients. The aim of this study was to reappraise the clinical course of HSE in different patient populations based on degree of immunocompetence and the presence or absence of underlying esophageal disease. METHODS Patients with histopathologically confirmed HSE identified from the Mayo Clinic pathology database from 2006 to 2016 were included in this study. Relevant demographic, clinical, and endoscopic data were retrospectively reviewed and compared between two cohorts: (a) immunocompromised and immunocompetent patients and (b) patients with and without underlying esophageal disorders. RESULTS Forty-six patients were included in the study. The most common presenting symptoms were odynophagia (34.8%) and dysphagia (30.4%). Thirty-three (71.7%) patients were immunocompromised, and these patients who experienced longer duration of symptoms (25.5 ± 23.4 days vs. 7.0 ± 5.5 days, p = 0.04) were more likely to require an extension of treatment course (38.1% vs. 8.3%, p = 0.05) compared to their immunocompetent counterparts. Seventeen (37%) patients had underlying esophageal disease, and these patients were more likely to have concomitant esophageal candidiasis (41.2% vs. 10.3%, respectively; p = 0.01). CONCLUSION Herpes simplex virus causes esophagitis in both immunocompetent and immunocompromised patients. While the disease course appears to be self-limited for all patient populations, clinical and endoscopic differences in the disease presentation and clinical course based on immune status and the presence or absence of underlying esophageal disease exist.
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Affiliation(s)
| | - Amrit K Kamboj
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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14
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Jung KH, Choi J, Gong EJ, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kim DH, Kim SH. Can endoscopists differentiate cytomegalovirus esophagitis from herpes simplex virus esophagitis based on gross endoscopic findings? Medicine (Baltimore) 2019; 98:e15845. [PMID: 31169688 PMCID: PMC6571398 DOI: 10.1097/md.0000000000015845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Differential diagnosis between herpes simplex virus (HSV) esophagitis and cytomegalovirus (CMV) esophagitis is challenging because there are many similarities and overlaps between their endoscopic features. The aims of this study were to investigate the implications of the endoscopic findings for the diagnosis of HSV and CMV esophagitis, and to develop a predictive model for differentiating CMV esophagitis from HSV esophagitis.Patients who underwent endoscopic examination and had pathologically-confirmed HSV or CMV esophagitis were eligible. Clinical characteristics and endoscopic features were retrospectively reviewed and categorized. A predictive model was developed based on parameters identified by logistic regression analysis.During the 8-year study period, HSV and CMV esophagitis were diagnosed in 85 and 63 patients, respectively. The endoscopic features of esophagitis were categorized and scored as follows: category 1 (-3 points): discrete ulcers or ulcers with vesicles, bullae, or pseudomembranes, category 2 (-2 points): coalescent or geographic ulcers, category 3 (1 points): ulcers with an uneven base, friability, or with a circumferential distribution, category 4 (2 points): punched-out, serpiginous, or healing ulcers with yellowish exudates. And previous history of transplantation (2 point) was included in the model as a discriminating clinical feature. The optimal cutoff point of the prediction model was 0 (area under receiver operating characteristic curve: 0.967), with positive scores favoring CMV esophagitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 96.8%, 89.4%, 92.6%, 87.3%, and 97.5%, respectively.The predictive model based on endoscopic and clinical findings appears to be accurate and useful in differentiating CMV esophagitis from HSV esophagitis.
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Affiliation(s)
- Kyung Hwa Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Jonggi Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Eun Jeong Gong
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangwon, Republic of Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine
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15
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Hoversten P, Kamboj AK, Katzka DA. Infections of the esophagus: an update on risk factors, diagnosis, and management. Dis Esophagus 2018; 31:5123414. [PMID: 30295751 DOI: 10.1093/dote/doy094] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/11/2022]
Abstract
Infectious esophagitis is a leading cause of esophagitis worldwide. While esophageal infections have traditionally been associated with immunocompromised patients, these disorders are becoming increasingly recognized in immunocompetent individuals. The three most common etiologies of infectious esophagitis are Candida, herpes simplex virus, and cytomegalovirus. Human papilloma virus infection can also involve the esophagus in the form of ulcerative lesions and papillomas. Less common etiologies include various other fungal, bacterial, and viral organisms. This review provides a comprehensive update on risk factors, diagnosis, and management of both common and less common infections of the esophagus.
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Affiliation(s)
- P Hoversten
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - A K Kamboj
- Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - D A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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16
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Walker C, Huber-Schumacher S, Boettler T, Thimme R, Fischer A. A rare cause of upper GI bleeding in a critically ill patient. Gut 2016; 65:1438. [PMID: 26719301 DOI: 10.1136/gutjnl-2015-310564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 12/06/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Christine Walker
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | | | - Tobias Boettler
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
| | - Andreas Fischer
- Department of Medicine II, University Hospital Freiburg, Freiburg, Germany
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17
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Wang HW, Kuo CJ, Lin WR, Hsu CM, Ho YP, Lin CJ, Su MY, Chiu CT, Chen KH. Clinical Characteristics and Manifestation of Herpes Esophagitis: One Single-center Experience in Taiwan. Medicine (Baltimore) 2016; 95:e3187. [PMID: 27057845 PMCID: PMC4998761 DOI: 10.1097/md.0000000000003187] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
We aimed to investigate the clinical characteristics of patients with herpes esophagitis (HE) based on endoscopic typing.Herpes simplex virus infection in the gastrointestinal tract primarily affects the esophagus. However, little is known about the presentation, endoscopic findings, and outcomes of HE.From 2003 to 2013, 47 patients with HE were identified histologically from among 1843 patients with esophageal ulcers. Personal data, underlying disease, esophagogastroduodenoscopy indication, endoscopic characteristics, pathological findings, laboratory data, and outcomes were collected. Endoscopic findings were classified into 3 types based on gross appearance and were correlated with clinical presentation.The mean age of patients was 62.04 ± 14.76 years, and most patients were men (39/47, 83%). The most common symptoms were odynophagia/dysphagia (20/47, 42.6%). Whereas 25 patients (53.2%) were diagnosed with malignancy, it was related to human immunodeficiency virus in only 1 patient (2.1%). HE was classified into 3 types based on endoscopic images: type I (n = 19), type II (n = 10), and type III (n = 18). The majority of patients with HE type III had sepsis (72%) and obvious leukocytosis than the other 2 types (P = 0.03). The overall mortality rate was 6.4% (3/47), and most of the patients who died (66.7% [2/3]) belonged to the endoscopic classification type III group. Clinical parameters were analyzed for the risk of poor outcome. Postchemotherapy and/or radiotherapy were associated with 30-day mortality after appearance of HE (P < 0.05).Herpes esophagitis primarily affects men and patients with malignancy or sepsis. However, the disease is usually self-limiting, and HE-related mortality is low. Relationship between severity of endoscopic findings and patients' outcome remains questionable. Further prospective study is needed.
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Affiliation(s)
- Hung-Wei Wang
- From the Department of Gastroenterology and Hepatology (H-WW, C-JK, W-RL, C-MH, Y-PH, C-JL, M-YS, C-TC), Chang Gung Memorial Hospital; Chang Gung University (C-JK, W-RL, M-YS, C-TC), College of Medicine; and Department of Pathology (K-HC), Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Smith LA, Gangopadhyay M, Gaya DR. Catastrophic gastrointestinal complication of systemic immunosuppression. World J Gastroenterol 2015; 21:2542-2545. [PMID: 25741165 PMCID: PMC4342934 DOI: 10.3748/wjg.v21.i8.2542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/04/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.
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Abstract
Herpes esophagitis due to infection with herpes simplex virus typically occurs in immunocompromised patients such as those with human immunodeficiency virus, malignancy, and those undergoing immunosuppressive therapy. Albeit rare, herpes esophagitis can occur in immunocompetent patients as a primary infection. We present a case of herpes esophagitis after corticosteroid treatment for back pain including epidural steroid injections. Corticosteroids, especially local injections, are a common treatment for chronic back pain, but they are not without risk. Epidural steroid injections can have systemic effects, which may go unrecognized and underappreciated. Although local infections have been reported after administering these injections, systemic immune suppression may allow for unexpected infections such as herpes esophagitis. Given the widespread use of epidural steroid injections, physicians should reevaluate the potential for harm when considering this treatment.
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Dolan R, O'Duffy F, Seoighe D, Dias A, Earley M, O'Dwyer T. Novel use of a supraclavicular transverse cervical artery customised perforator flap: A paediatric emergency. J Plast Reconstr Aesthet Surg 2013; 66:1138-41. [DOI: 10.1016/j.bjps.2012.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/18/2012] [Indexed: 11/30/2022]
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Jazeron JF, Barbe C, Frobert E, Renois F, Talmud D, Brixi-Benmansour H, Brodard V, Andréoletti L, Diebold MD, Lévêque N. Virological diagnosis of herpes simplex virus 1 esophagitis by quantitative real-time PCR assay. J Clin Microbiol 2012; 50:948-52. [PMID: 22170921 PMCID: PMC3295176 DOI: 10.1128/jcm.05748-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/05/2011] [Indexed: 12/12/2022] Open
Abstract
Herpes simplex virus 1 (HSV-1) esophagitis diagnosis is routinely based on the endoscopic findings confirmed by histopathological examination of the esophagitis lesions. Virological diagnosis is not systematically performed and restricted to viral culture or to qualitative PCR assay from esophagitis biopsy specimens. The aim of this study was to assess the interest of quantitative real-time PCR assay in HSV-1 esophagitis diagnosis by comparing the results obtained to those of histological examination associated with immunohistochemical staining, which is considered the "gold standard." From 53 esophagitis biopsy specimens, the PCR assay detected HSV-1 in 18 of 19 histologically proven to have herpetic esophagitis and in 9 of 34 that had esophagitis related to other causes, demonstrating sensitivity, specificity, positive predictive value, and negative predictive value of 94.7%, 73%, 66.7%, and 96%, respectively. Interestingly, HSV-1 was not detected in 16 specimens without the histological aspect of esophagitis. The viral loads normalized per μg of total extracted DNA in each biopsy specimen detected positive by HSV PCR were then compared and appeared to be significantly higher in histopathologically positive herpetic esophagitis (median = 2.9 × 10(6) ± 1.1 × 10(8)) than in histopathologically negative herpetic esophagitis (median = 3.1 × 10(3) ± 6.2 × 10(3)) (P = 0.0009). Moreover, a receiver operating characteristics analysis revealed that a viral load threshold greater than 2.5 × 10(4) copies would allow an HSV-1 esophagitis diagnosis with a sensitivity and specificity of 83.3% and 100%, respectively. In conclusion, this work demonstrated that HSV quantitative PCR results for paraffin-embedded esophageal tissue was well correlated to histopathological findings for an HSV-1 esophagitis diagnosis and could be diagnostic through viral load assessment when histopathological results are missing or uncertain.
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Affiliation(s)
| | - Coralie Barbe
- Clinical Research Coordination Unit, University Hospital of Reims, Reims, France
| | - Emilie Frobert
- Virology Department, University Hospital of Lyon, Lyon, France
| | - Fanny Renois
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Déborah Talmud
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | | | | | - Laurent Andréoletti
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | | | - Nicolas Lévêque
- Virology Department, University Hospital of Reims, Reims, France
- IFR 53/EA-4303, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
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Canalejo E, García Durán F, Cabello N, García Martínez J. Herpes esophagitis in healthy adults and adolescents: report of 3 cases and review of the literature. Medicine (Baltimore) 2010; 89:204-210. [PMID: 20616659 DOI: 10.1097/md.0b013e3181e949ed] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Herpes esophagitis (HE) is common in immunosuppressed patients, but has rarely been reported in immunocompetent individuals, in whom it appears to be a self-limited illness. We describe 3 new cases of HE in otherwise healthy patients seen in our hospital within the last 5 years. We performed a comprehensive review of the previously reported cases of HE in immunocompetent adults and adolescents in the English and Spanish literature. We analyzed the clinical features, treatment, and outcome of this entity. A total of 56 patients were included (39 men and 17 women), with a mean age of 35 years. The most common clinical manifestations were odynophagia (60.7%), fever (51.8%), and retrosternal chest pain (46.4%). A prodrome of upper respiratory symptoms and concurrent orolabial herpetic lesions were present in 26.8% and 25% of cases, respectively. Gastrointestinal bleeding was a rare complication (5.3%). Endoscopy revealed multiple ulcers in most cases (58.9%), typically involving the distal or mid-esophagus (83%). The diagnosis was confirmed by histopathologic examination in 40 cases (71.4%), by tissue viral culture in 21 (37.5%), and by detection of viral genome in esophageal samples in 4 cases (7.1%). Herpes simplex virus type 1 (HSV-1) was identified in 27 cases and herpes simplex virus type 2 (HSV-2) only in 1 case. Serology was consistent with a primary infection in 11 of the 25 evaluable cases (44%). Acyclovir therapy was used in 45.4% of patients. The outcome was favorable in all cases, although an esophageal perforation occurred in 1 patient. HE is a rare but well-defined entity in healthy adults and adolescents, and is probably underdiagnosed. A high degree of suspicion and a prompt endoscopic examination are required for the diagnosis. It is usually a self-limited infection, but early treatment with acyclovir may hasten the resolution of symptoms. Nevertheless, the benefit of antiviral therapy remains unknown.
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Affiliation(s)
- Eduardo Canalejo
- From Infectious Diseases Unit, Department of Internal Medicine (EC, NC); Department of Gastroenterology (FGD); and Department of Microbiology (JGM), Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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23
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Boersma CC, Borowitz SM. Odynophagia. Clin Pediatr (Phila) 2007; 46:556-7. [PMID: 17579111 DOI: 10.1177/0009922806294798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carol C Boersma
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia 22908, USA
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Lee TO, Hwang HS, Moon SM, Choi SK. A Case of Postoperative Herpes Simplex Pneumonia. J Korean Neurosurg Soc 2007. [DOI: 10.3340/jkns.2007.41.3.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tae One Lee
- Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea
| | - Hyung Sik Hwang
- Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea
| | - Seung Myung Moon
- Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea
| | - Sun Kil Choi
- Department of Neurosurgery, College of Medicine, Hallym University, Seoul, Korea
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Moretti F, Uberti-Foppa C, Quiros-Roldan E, Fanti L, Lillo F, Lazzarin A. Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case. J Clin Pathol 2002; 55:397-8. [PMID: 11986352 PMCID: PMC1769657 DOI: 10.1136/jcp.55.5.397] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2-3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS.
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Affiliation(s)
- F Moretti
- Institute of Infectious and Tropical Diseases, University of Brescia, 25123 Brescia, Italy.
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Ramanathan J, Rammouni M, Baran J, Khatib R. Herpes simplex virus esophagitis in the immunocompetent host: an overview. Am J Gastroenterol 2000; 95:2171-6. [PMID: 11007213 DOI: 10.1111/j.1572-0241.2000.02299.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to delineate the characteristics of herpes simplex virus esophagitis (HSVE) in the immunocompetent host. METHODS The study entailed a case report and a review of relevant literature through a MEDLINE search back to 1966. All cases with documented HSVE in patients without immunosuppression were selected and their characteristics defined. RESULTS A total of 38 cases were identified. The age range was 1-76 yr and the male/female ratio 3.2/1. Antecedent exposure to HSV disease was described in eight cases (21.1%). A prodrome of systemic manifestations preceded the onset of esophageal symptoms in nine subjects (23.6%). Manifestations included acute odynophagia (76.3%), heartburn (50%), and fever (44.7%). Concurrent oropharyngeal lesions were uncommon (n = 8, 21.1%). Endoscopically, extensive involvement was common, showing friable mucosa (84.2%), numerous ulcers (86.8%), and whitish-exudates (39.5%). The distal esophagus was most commonly affected (63.8%). Microscopic examination showed characteristic viral cytopathology in 26 (68.4%) cases. Virus was recovered from esophageal-brushes or biopsies in 23 of 24 (95.8%) patients and immunocytochemistry was positive in seven of eight (87.5%) cases. Immune status was consistent with primary HSV infection in eight (21.1%) cases. The disease was self-limiting, although esophageal perforation and upper GI bleeding were reported in one case each. CONCLUSIONS HSVE in the immunocompetent host is a rare but distinct entity, and is significantly more common in male subjects. It represents either primary infection or reactivation, and is characterized by acute onset, systemic manifestations, and extensive erosive-ulcerative involvement of the mid-distal esophagus. Histopathological examination alone may miss the diagnosis; adding tissue-viral culture optimizes the diagnostic sensitivity. It is usually self-limiting; whether antiviral therapy is beneficial remains unknown.
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Affiliation(s)
- J Ramanathan
- Department of Medicine, St. John Hospital and Medical Center, Detroit, Michigan 48236, USA
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