1
|
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
| |
Collapse
|
2
|
Hosoda K, Nakamura N, Suzuki R, Takahashi Y, Naganuma M. Herpetic esophagitis in healthy young adult. Clin J Gastroenterol 2023; 16:803-806. [PMID: 37713095 DOI: 10.1007/s12328-023-01852-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023]
Abstract
Herpetic esophagitis (HE) is common in immunocompromised patients but rarely reported in healthy young adults. A 28-year-old healthy male patient visited our clinic with a chief complaint of chest pain. An esophagogastroduodenoscopy revealed widely spread superficial multiple ulcers in the middle to the distal esophagus, and repeated biopsies from the ulcer were performed but revealed inconsistent findings with HE. Thus, he was clinically diagnosed with HE based on endoscopic findings and serologic tests of immunoglobulin M (IgM)/immunoglobulin G (IgG) for herpes simplex virus. He responded to valacyclovir, and all esophageal ulcers had scarred.
Collapse
Affiliation(s)
- Koki Hosoda
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Naohiro Nakamura
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan.
| | - Ryo Suzuki
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Yu Takahashi
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, 2-5-1 Shin-Machi, Hirakata, Osaka, 573-1010, Japan
| |
Collapse
|
3
|
Shah R, Patel S, Henriquez R, Parikh J, Mandalia A. Herpes Simplex Virus Esophagitis in an Immunocompetent Patient. Cureus 2023; 15:e44668. [PMID: 37799253 PMCID: PMC10550305 DOI: 10.7759/cureus.44668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Esophagitis due to herpes simplex virus (HSV) infection is a rare entity in the immunocompetent population. It is usually seen in immunocompromised hosts, those with human immunodeficiency virus (HIV) infection, malignancies, and patients on immunosuppressive medications. We present a case of a young immunocompetent man with anabolic steroid use who presented with esophagitis symptoms found to be from HSV infection. So far, the use of corticosteroids has been reported as a predisposing factor for HSV esophagitis in immunocompetent hosts in multiple case reports. However, our case suspects that transient immunosuppression with similar medication can cause HSV esophagitis in otherwise immunocompetent hosts.
Collapse
Affiliation(s)
- Raj Shah
- Internal Medicine, University of Central Florida College of Medicine / Hospital Corporation of America Healthcare Graduate Medical Education, Orlando, USA
| | - Stuti Patel
- Internal Medicine, Western Reserve Health Education, Trumbull Regional Medical Center, Warren, USA
| | - Richard Henriquez
- Internal Medicine, University of Central Florida College of Medicine / Hospital Corporation of America Healthcare Graduate Medical Education, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Amar Mandalia
- Gastroenterology, Orlando Veterans Affairs Medical Center, Orlando, USA
| |
Collapse
|
4
|
Sousa B, Silva J, Araújo E, Costa R, Calheiros A. Herpetic Esophagitis: A Cause of Dysphagia in a Malnourished Patient. Cureus 2023; 15:e43858. [PMID: 37736443 PMCID: PMC10510948 DOI: 10.7759/cureus.43858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Herpetic esophagitis (HE) is an esophageal infection caused by herpes simplex virus (HSV). Although less common, it can occasionally affect immunocompetent hosts. It can manifest as odynophagia and/or dysphagia and should lead to an investigation by upper digestive endoscopy with a biopsy. The authors report a case of a 65-year-old man with a past medical history relevant for schizophrenia, oligophrenia, and malnutrition, and no other history or evidence of immunosuppression, who presented with severe dysphagia over weeks and recent episodes of food aspiration with consequent pneumonia. An upper gastrointestinal endoscopy was performed, revealing severe stenosis at the level of the gastroesophageal junction with scar tissue, not transposable with the endoscope. The biopsy led to the diagnosis of hepatic esophagitis. Despite the immunocompetent status (excepting only the risk factor malnutrition) and treatment with acyclovir, with initial clinical improvement, the patient died a few weeks after diagnosis after multiple respiratory complications such as nosocomial infection. This case highlights that herpetic esophagitis is sometimes observed in immunocompetent hosts. HE has a self-limited course, with severe complications more frequent in immunosuppressed patients. However, it is also important to suspect this condition in immunocompetent patients and look for risk factors, given the potential morbidity this disease entails. In this group of patients, the presence of predisposing factors and associated comorbidities, such as malnutrition, alcohol consumption, or use of corticosteroids, have been associated with the development of viral esophagitis (including HE). HE remains a clinical challenge, especially in patients with risk factors for immunosuppression, such as malnutrition, as in the reported case.
Collapse
Affiliation(s)
- Bárbara Sousa
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Joana Silva
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Elsa Araújo
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Raquel Costa
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| | - Andre Calheiros
- Internal Medicine, Unidade Local de Saúde do Alto Minho (ULSAM), Ponte de Lima, PRT
| |
Collapse
|
5
|
Prolonged Intractable Hiccups Associated with HSV (I&II) Esophagitis and H. pylori Gastritis. Case Rep Infect Dis 2023; 2023:3561895. [PMID: 36896422 PMCID: PMC9991465 DOI: 10.1155/2023/3561895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
An immunocompetent male presented with an intractable hiccup. EGD revealed circumferential ulceration of middistal esophagus and biopsies confirmed HSV (I&II) esophagitis and H. pylori gastritis. He was prescribed triple therapy for H. pylori and acyclovir for HSV esophagitis. HSV esophagitis and H. pylori should be included in differential for intractable hiccups.
Collapse
|
6
|
Bhattarai AM, Rokaya P, Sharma R, Karki A, Roka K. Iron-deficiency anemia following herpetic esophagitis in a previously healthy female. Ann Med Surg (Lond) 2022; 84:104839. [PMID: 36582881 PMCID: PMC9793130 DOI: 10.1016/j.amsu.2022.104839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/30/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Herpetic Esophagitis is caused by the Herpes Simplex virus, which generally affects immunocompromised individuals and is rarely seen in healthy individuals. Symptoms are usually self-limiting. Case presentation We report the case of a 68-year-old female who presented with odynophagia, dysphagia, and epigastric pain with no other underlying disease. Endoscopic findings of soft, nodular, and friable growths just above the squamocolumnar junction with diffuse ulcerations in the distal esophagus, led to the diagnosis. It was confirmed with a histopathological report which revealed multinucleated giant cells with eosinophilic intranuclear inclusions. During follow-up, laboratory investigations revealed iron deficiency anemia, which was the consequence of GI bleeding. Clinical discussion Herpes Simplex virus esophagitis can occur in immunocompetent individuals and even it can cause food impaction and GI bleeding, which can lead to Iron deficiency anemia. Conclusion Hence, follow-up of patients is important for early diagnosis and intervention of any complications that may arise.
Collapse
Affiliation(s)
| | - Pooja Rokaya
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal,Corresponding author.
| | - Riya Sharma
- KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Abinash Karki
- Department of Medicine, Shree Birendra Hospital, Kathmandu, Nepal
| | - Kumar Roka
- Department of Medicine, Shree Birendra Hospital, Kathmandu, Nepal
| |
Collapse
|
7
|
Kim M, Jalal A, Rubio-Gomez H, Bromberg R. A case report of severe systemic herpes simplex virus-1 (HSV-1) infection with multi-organ involvement after a course of oral corticosteroid treatment. BMC Infect Dis 2022; 22:817. [DOI: 10.1186/s12879-022-07815-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Herpes simplex virus (HSV) rarely causes organ-invasive infection. Diagnosis and treatment for such infections are often delayed, and mortality is high. We present the first reported case of disseminated HSV-1 infection in an adult causing liver failure, myocarditis, and encephalitis in a patient who recovered after receiving parenteral acyclovir treatment.
Case presentation
A 46-year-old female presented with fever, chills, and malaise after 2 weeks of oral corticosteroid treatment for uveitis. She was diagnosed with disseminated HSV-1 infection with multi-organ involvement causing hepatitis, encephalitis, and myocarditis. Diagnosis was made timely using serum polymerase chain reaction (PCR) for HSV DNA and the patient was given intravenous acyclovir treatment promptly, which led to her survival without significant morbidity.
Conclusions
Clinicians should have a low threshold for suspecting HSV infection and ordering HSV PCR to decrease morbidity and mortality when there is a high clinical suspicion of systemic HSV infection with multi-organ involvement. Serum PCR for HSV DNA is an excellent modality for an initial diagnostic approach. Further research is warranted to elucidate causality between a course of corticosteroid therapy and systemic HSV-1 infection without major immunosuppressive comorbidities or treatments.
Collapse
|
8
|
Ohta R, Sano C. A Rare Case of Herpes Esophagitis in an Immunocompetent Elderly Patient. Cureus 2022; 14:e21854. [PMID: 35291518 PMCID: PMC8897719 DOI: 10.7759/cureus.21854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
Herpes esophagitis is common among immunocompromised hosts but is relatively rare among immunocompetent patients. Its symptoms are vague because many different symptoms can be induced by esophageal lesions. Here, we report a case of herpes esophagitis in an elderly immunocompetent patient. A 91-year-old woman visited our community hospital with a complaint of appetite loss for several days. Although she did not have any symptoms of epigastric, oral, or retrosternal pain, multiple ulcers were detected in her esophagus. Biopsy of the edge of the ulcer showed giant cells, indicating a herpes virus infection. She was diagnosed with herpes esophagitis and treated with acyclovir for one week. Her symptoms completely resolved after treatment, and she was discharged. Herpes esophagitis can manifest as vague symptoms in immunocompetent elderly patients. Therefore, herpes esophagitis must be considered in the differential diagnosis of elderly patients presenting with vague symptoms.
Collapse
|
9
|
Rajasekaran V, Rahaman V, Hou X, Steele RW. HSV Esophagitis in an Immunocompetent 17-Year-Old. Glob Pediatr Health 2021; 8:2333794X211052914. [PMID: 34841008 PMCID: PMC8613879 DOI: 10.1177/2333794x211052914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Herpes Simplex Virus (HSV) esophagitis is a relatively rare form of infectious esophagitis. Typically, patients with viral esophagitis are immunocompromised. HSV esophagitis in an immunocompetent patient is uncommonly reported. The objective of this case report is to discuss symptoms, investigations, imaging, and treatment of HSV esophagitis in a healthy adolescent male. A previously healthy 17-year-old male presented to the ED of our facility with a 5-day history of fever, odynophagia, lethargy, and 2 episodes of emesis that failed to resolve with antibiotic treatment. Investigations revealed a low platelet count, mild hyponatremia, hypochloremia, and an elevated AST and ALT. A respiratory infection panel as well as CMV IgG, HIV, Rickettsia, and EBV tests were negative. HSV-1 PCR was positive and upper endoscopy revealed a friable mucosa, erythema, and exudates in the lower esophagus and erythematous duodenopathy. The patient received a diagnosis of HSV esophagitis and was treated with a 14-day course of IV to PO acyclovir. There was a rapid improvement of his symptoms with antiviral therapy.
Collapse
Affiliation(s)
- Vedika Rajasekaran
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Victoria Rahaman
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Xing Hou
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Russell W Steele
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| |
Collapse
|
10
|
Upadhaya Regmi B, Subedi RC, Mandal SK, Kunwar S, Karki B. Herpes simplex esophagitis in an immunocompetent host: a case report. Oxf Med Case Reports 2021; 2021:omab091. [PMID: 34729190 PMCID: PMC8557428 DOI: 10.1093/omcr/omab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
Esophagitis caused by Herpes Simplex virus is a well-recognized opportunistic infection in the immunocompromised or severely ill host. However, it is uncommon in otherwise immunocompetent host. It usually responds well to a course of acyclovir. We report a case of young female without any other immunocompromised state who presented with severe dysphagia. She was diagnosed endoscopically and later with histopathology and recovered well after a course of acyclovir.
Collapse
Affiliation(s)
- Binit Upadhaya Regmi
- Department of Medicine, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Ram Chandra Subedi
- Department of Medicine, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sujit Kumar Mandal
- Department of Medicine, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Shova Kunwar
- Department of Pathology, Shree Birendra Hospital, Nepalese Army of Institute of Health Sciences, Kathmandu, Nepal
| | - Binod Karki
- Department of Medicine, Shree Birendra Hospital, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| |
Collapse
|
11
|
Pouw RE, Barret M, Biermann K, Bisschops R, Czakó L, Gecse KB, de Hertogh G, Hucl T, Iacucci M, Jansen M, Rutter M, Savarino E, Spaander MCW, Schmidt PT, Vieth M, Dinis-Ribeiro M, van Hooft JE. Endoscopic tissue sampling - Part 1: Upper gastrointestinal and hepatopancreatobiliary tracts. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:1174-1188. [PMID: 34535035 DOI: 10.1055/a-1611-5091] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
1: ESGE recommends that, where there is a suspicion of eosinophilic esophagitis, at least six biopsies should be taken, two to four biopsies from the distal esophagus and two to four biopsies from the proximal esophagus, targeting areas with endoscopic mucosal abnormalities. Distal and proximal biopsies should be placed in separate containers.Strong recommendation, low quality of evidence. 2: ESGE recommends obtaining six biopsies, including from the base and edge of the esophageal ulcers, for histologic analysis in patients with suspected viral esophagitis.Strong recommendation, low quality of evidence. 3: ESGE recommends at least six biopsies are taken in cases of suspected advanced esophageal cancer and suspected advanced gastric cancer.Strong recommendation, moderate quality of evidence. 4: ESGE recommends taking only one to two targeted biopsies for lesions in the esophagus or stomach that are potentially amenable to endoscopic resection (Paris classification 0-I, 0-II) in order to confirm the diagnosis and not compromise subsequent endoscopic resection.Strong recommendation, low quality of evidence. 5: ESGE recommends obtaining two biopsies from the antrum and two from the corpus in patients with suspected Helicobacter pylori infection and for gastritis staging.Strong recommendation, low quality of evidence. 6: ESGE recommends biopsies from or, if endoscopically resectable, resection of gastric adenomas.Strong recommendation, moderate quality of evidence. 7: ESGE recommends fine-needle aspiration (FNA) and fine-needle biopsy (FNB) needles equally for sampling of solid pancreatic masses.Strong recommendation, high quality evidence. 8: ESGE suggests performing peroral cholangioscopy (POC) and/or endoscopic ultrasound (EUS)-guided tissue acquisition in indeterminate biliary strictures. For proximal and intrinsic strictures, POC is preferred. For distal and extrinsic strictures, EUS-guided sampling is preferred, with POC where this is not diagnostic.Weak recommendation, low quality evidence. 9: ESGE suggests obtaining possible non-neoplastic biopsies before sampling suspected malignant lesions to prevent intraluminal spread of malignant disease.Weak recommendation, low quality of evidence. 10: ESGE suggests dividing EUS-FNA material into smears (two per pass) and liquid-based cytology (LBC), or the whole of the EUS-FNA material can be processed as LBC, depending on local experience.Weak recommendation, low quality evidence.
Collapse
Affiliation(s)
- Roos E Pouw
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, Amsterdam University Medical Centers location VUmc, Amsterdam, The Netherlands
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital and University of Paris, Paris, France
| | - Katharina Biermann
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location AMC, Amsterdam, The Netherlands
| | - Gert de Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Hucl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marietta Iacucci
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy and NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marnix Jansen
- Department of Histopathology, University College London Hospital, London, UK
| | - Matthew Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter T Schmidt
- Department of Medicine (Solna), Karolinska Institute and Department of Medicine, Ersta Hospital, Stockholm, Sweden
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
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]
|
13
|
Quera R, Sassaki LY, Núñez P, Contreras L, Bay C, Flores L. Herpetic Esophagitis and Eosinophilic Esophagitis: A Potential Association. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933565. [PMID: 34565790 PMCID: PMC8486434 DOI: 10.12659/ajcr.933565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. CASE REPORT We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyte exudate in granulation tissue and nuclear inclusions with a viral appearance. The immunohistochemical study for herpes simplex virus (HSV) was positive. The patient was treated symptomatically and progressed favorably. The endoscopic control carried out at 3 months showed longitudinal grooves and trachealization, findings compatible with the diagnosis of eosinophilic esophagitis and with biopsies that confirmed the etiology by showing an increase in eosinophil count >20 per field, without isolating HSV. CONCLUSIONS This clinical case confirms the possible relationship between esophagitis caused by HSV and eosinophilic esophagitis. Alterations at the immune level and damage to the esophageal mucosa barrier may explain this relationship. In this scenario, an endoscopic follow-up should be considered.
Collapse
Affiliation(s)
- Rodrigo Quera
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
- Corresponding Author: Rodrigo Quera, e-mail:
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, SP, Brazil
| | - Paulina Núñez
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
- Department of Gastroenterology, Hospital San Juan de Dios, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis Contreras
- Departament of Pathological Anatomy, Clinica Universidad de los Andes, Santiago, Chile
| | - Constanza Bay
- Department of Pediatrics, Faculty of Medicine, Pontifica Universidad Catòlica, Santiago, Chile
| | - Lilian Flores
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
| |
Collapse
|
14
|
The Impact of Human Herpesviruses in Clinical Practice of Inflammatory Bowel Disease in the Era of COVID-19. Microorganisms 2021; 9:microorganisms9091870. [PMID: 34576764 PMCID: PMC8468540 DOI: 10.3390/microorganisms9091870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Human herpesviruses (HHVs): herpes simplex virus (HSV) types 1 (HSV-1) and 2 (HSV-2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), HHV-6, HHV-7, and HHV-8, are known to be part of a family of DNA viruses that cause several diseases in humans. In clinical practice of inflammatory bowel disease (IBD), the complication of CMV enterocolitis, which is caused by CMV reactivation under disruption of intestinal barrier function, inflammation, or strong immunosuppressive therapy, is well known to affect the prognosis of disease. However, the relationship between other HHVs and IBD remains unclear. In the transplantation field, reactivation of other viruses, such as HHV-6, could cause colitis under immunosuppressed condition. Recent research revealed that combined infection of some HHVs could be a risk factor for colectomy in patients with ulcerative colitis. This suggests that it would be important to clarify HHV behavior in the treatment for patients with IBD, especially in those under immunosuppressive therapies. Looking at the relationship with recently emerged novel coronaviruses (SARS-CoV-2), there are reports describe that SARS-CoV-2 might induce reactivation of HSV-1, EBV, VZV (herpes zoster), and HHV-6/7. If SARS-CoV-2 infection becomes common, vigilance against HHV reactivation may become more crucial. In this review, we discuss the impact of HHVs in clinical practice of inflammatory bowel diseases, especially during the SARS-CoV-2 pandemic.
Collapse
|
15
|
Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
Collapse
Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| |
Collapse
|
16
|
Paul A, Ghose A. Herpes simplex virus-1 oesophagitis presenting with persistent hiccough in an immunocompetent host: A case report. Trop Doct 2021; 51:601-602. [PMID: 34152226 DOI: 10.1177/00494755211022519] [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: 11/16/2022]
Abstract
Herpes simplex virus-1 (HSV-1) oesophagitis as an aetiology of persistent hiccough is a rarity in immunocompetent hosts and entails an exhaustive diagnostic work-up, since it does not present with any of the typical oesophagitis symptoms. Our patient presented with persistent hiccoughs that were resistant to treatment with baclofen. Oesophagogastroduodenoscopy with biopsy confirmed the diagnosis of HSV-1 oesophagitis. The hiccough subsided within 48 h of aciclovir therapy.
Collapse
Affiliation(s)
- Aritra Paul
- Intern in General Medicine, Nil Ratan Sircar Medical College & Hospital, Kolkata, India
| | - Aruni Ghose
- Clinical Fellow in Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
A Patient with Eosinophilic Esophagitis and Herpes Simplex Esophagitis: A Case Report and Literature Review. Case Rep Gastrointest Med 2021; 2021:5519635. [PMID: 34123440 PMCID: PMC8169267 DOI: 10.1155/2021/5519635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
Acute herpes simplex esophagitis (HSE) is common in immunocompromised patients. Eosinophilic esophagitis (EoE) is characterized by immune-mediated eosinophil-predominant esophageal inflammation. We report a patient with human immunodeficiency virus infection who presented with dysphagia and odynophagia and was found to have HSE and EoE. The combination of these two relatively rare conditions suggests possible predisposition.
Collapse
|
19
|
Haider MB, Basida B, Bapatla A, Ismail R, Hafeez W. Herpes Simplex Virus Esophagitis in the Setting of Acute Use of Corticosteroids for COPD Exacerbation in an Immunocompetent Middle-Aged Woman. Case Rep Gastroenterol 2021; 15:616-620. [PMID: 34616265 PMCID: PMC8454247 DOI: 10.1159/000515413] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Herpes simplex (HSV) esophagitis is usually identified in patients with significant immunosuppressive conditions such as AIDS. Short course of immunosuppressive therapy is an uncommon risk factor for this condition. We present a case of acute gastrointestinal bleeding secondary to HSV type 1-induced esophageal ulcers. A 63-year-old woman developed acute hypoxic hypercapnic respiratory failure. Past medical history was significant for COPD for which the patient was taking short-acting bronchodilator inhalers. The patient was intubated and started on mechanical ventilation. Intravenous Solu-Medrol 40 mg Q6 was started. Hospital course was complicated by sepsis of unknown source. Empiric broad-spectrum antibiotic therapy was started. On the 11th hospital day, the patient experienced multiple episodes of coffee ground emesis. There was abdominal tenderness on physical examination. Significant laboratory results were lipase 1,911 U/L and lymphopenia (ALC = 300/mm3). Endoscopy revealed severe erosive esophagitis and multiple punched-out ulcerations of the esophagus. Empiric treatment with valacyclovir 500 mg OD was started. The patient required PEG tube insertion for dysphagia. Complete resolution of esophagitis was noted then. Immunohistochemical staining for HSV was strongly positive in the cells with inclusions. Short course of intravenous corticosteroids is an uncommon cause of HSV-1 esophagitis. Corticosteroid-induced lymphopenia impedes underlying cellular immunity, which might explain the reactivation of latent herpes and esophageal ulcer formation. Given the rarity of the disease, evidence of treatment is available from case reports only. We found complete resolution of esophageal ulcers after the patient received valacyclovir therapy for 10 days.
Collapse
Affiliation(s)
- Maryam Bilal Haider
- Department of Internal Medicine, Detroit Medical Center/Wayne State University Sinai Grace Hospital, Detroit, Michigan, USA
| | | | | | | | | |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
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]
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Machine learning approach for differentiating cytomegalovirus esophagitis from herpes simplex virus esophagitis. Sci Rep 2021; 11:3672. [PMID: 33574361 PMCID: PMC7878749 DOI: 10.1038/s41598-020-78556-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022] Open
Abstract
The endoscopic features between herpes simplex virus (HSV) and cytomegalovirus (CMV) esophagitis overlap significantly, and hence the differential diagnosis between HSV and CMV esophagitis is sometimes difficult. Therefore, we developed a machine-learning-based classifier to discriminate between CMV and HSV esophagitis. We analyzed 87 patients with HSV esophagitis and 63 patients with CMV esophagitis and developed a machine-learning-based artificial intelligence (AI) system using a total of 666 endoscopic images with HSV esophagitis and 416 endoscopic images with CMV esophagitis. In the five repeated five-fold cross-validations based on the hue-saturation-brightness color model, logistic regression with a least absolute shrinkage and selection operation showed the best performance (sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve: 100%, 100%, 100%, 100%, 100%, and 1.0, respectively). Previous history of transplantation was included in classifiers as a clinical factor; the lower the performance of these classifiers, the greater the effect of including this clinical factor. Our machine-learning-based AI system for differential diagnosis between HSV and CMV esophagitis showed high accuracy, which could help clinicians with diagnoses.
Collapse
|
24
|
Panarelli NC. Infectious diseases of the upper gastrointestinal tract. Histopathology 2020; 78:70-87. [PMID: 33382485 DOI: 10.1111/his.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person-to-person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.
Collapse
|
25
|
Antaki N, Aljarad Z, Dabbas H, Haddad W, Akil MA, Tarabishi AS. Epigastric pain associated with herpes esophagitis: case report. BMC Infect Dis 2020; 20:754. [PMID: 33054791 PMCID: PMC7557039 DOI: 10.1186/s12879-020-05487-5] [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: 05/17/2020] [Accepted: 10/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Herpes esophagitis is uncommon disease caused by Herpes simplex virus (HSV). While the disease most often occurs in immunocompromised patients, including post-chemotherapy, immunosuppression with organ transplants, and in AIDS, Herpes esophagitis can also occur in immunocompetent individuals. Case presentation We report a case of herpes esophagitis in a 72 year- old woman who was presumed to be immunocompromised following prolonged radiotherapy and chemotherapy for lymphoma. Her main symptom was epigastric pain. Upper endoscopy showed multiple rounded ulcers in lower esophagus. The diagnosis was confirmed histologically by multiple biopsies. The patient received Valacyclovir for 2 weeks and started to get better within 3 days of treatment. Conclusion Although there are few published cases of Herpes esophagitis disease in the medical literature, we recommend that this disease should be considered as one of the differential diagnoses when assessing immuno-compromised patients presenting with non-specific abdominal symptoms.
Collapse
Affiliation(s)
| | - Ziad Aljarad
- Department of Internal Medicine, Faculty of Medicine, Aleppo University Hospital, University of Aleppo, Aleppo, Syria.
| | | | - Walid Haddad
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - M Amin Akil
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | |
Collapse
|
26
|
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.
Collapse
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)
| |
Collapse
|
27
|
Diezma-Martín AM, Gigante-Miravalles E, Castro Limo JD, Quimbayo Arcila CA, Puche Paniagua JJ. Herpetic esophagitis in immunocompentent host: cases report. BMC Infect Dis 2020; 20:605. [PMID: 32807089 PMCID: PMC7433066 DOI: 10.1186/s12879-020-05328-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022] Open
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.
Collapse
|
28
|
Affiliation(s)
- T Iida
- Department of Gastroenterology, Otaru City General Hospital, Otaru, Japan and Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - H Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
29
|
Lee MH, Lubner MG, Peebles JK, Hinshaw MA, Menias CO, Levine MS, Pickhardt PJ. Clinical, Imaging, and Pathologic Features of Conditions with Combined Esophageal and Cutaneous Manifestations. Radiographics 2019; 39:1411-1434. [PMID: 31419189 DOI: 10.1148/rg.2019190052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A variety of clinically significant conditions can affect both the esophagus and the skin. Esophageal and cutaneous manifestations may directly reflect the underlying disease process, as in infections such as herpes simplex virus, bullous diseases such as epidermolysis bullosa and mucous membrane pemphigoid, connective tissue diseases such as systemic sclerosis, and inflammatory diseases such as lichen planus. Alternatively, esophageal and cutaneous findings may result from conditions that are closely associated with and potentially pathognomonic for but distinct from the underlying disease process, as in genetic diseases such as Cowden syndrome or paraneoplastic syndromes such as acrokeratosis paraneoplastica. Other diseases such as Crohn disease may have cutaneous manifestations that directly reflect the same underlying inflammatory process that affects the gastrointestinal tract or cutaneous manifestations that represent reactive or associated conditions distinct from the underlying inflammatory process. The cutaneous manifestations of disease may precede, coincide with, or follow the esophageal manifestations of disease. The authors present the characteristic clinical features and imaging findings associated with common and uncommon conditions that have esophageal and cutaneous manifestations. Each condition is presented with a brief overview, discussion of salient clinical and cutaneous manifestations, and description of the typical esophageal imaging findings, with particular attention to implications for diagnosis, prognosis, and treatment. Recognition of potential associations between cutaneous lesions and esophageal imaging findings is important for establishing a specific diagnosis or generating a meaningful differential diagnosis.
Collapse
Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Meghan G Lubner
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - J Klint Peebles
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Molly A Hinshaw
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Christine O Menias
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Marc S Levine
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| | - Perry J Pickhardt
- From the Department of Radiology, Naval Medical Center Camp Lejeune, Camp Lejeune, NC (M.H.L.); Departments of Radiology (M.G.L., P.J.P.) and Dermatology (J.K.P., M.A.H.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.S.L.)
| |
Collapse
|
30
|
Mărginean CO, Meliţ LE, Mocan S, Mărginean MO, Mărginean CD. An uncommon case of herpetic esophagitis in a small child with allergic rhinitis: A case report and literature review (CARE compliant). Medicine (Baltimore) 2019; 98:e15601. [PMID: 31096465 PMCID: PMC6531067 DOI: 10.1097/md.0000000000015601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Herpetic esophagitis (HE) is a common condition in immunosuppressed patients, but a rare entity in immunocompetent patients affecting especially male teenagers and young adults. PATIENT CONCERNS We report the case of a 5-year-old male patient, with a history of allergic rhinitis admitted in our clinic for acute onset fever refractory to antipyretics, chest pain, anorexia, refusal of solid food, accepting only small amounts of fluids, odynophagia, and epigastric pain. The clinical exam revealed severe malaise, pallor, decreased skin turgor, abdominal epigastric tenderness, heartburn at palpation within the epigastric area. The laboratory tests showed leukocytosis, monocytosis, hypoglycaemia, and elevated inflammatory biomarkers. DIAGNOSES The serology tests for human immunodeficiency virus (HIV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) were negative, except for immunoglobulin G (IgG) anti-EBV which was positive. The chest radiography was normal, and the abdominal ultrasound showed abdominal bloating. The upper digestive endoscopy revealed friable esophageal mucosa, with multiple ulceration on the entire esophagus, and whitish exudates especially on the middle and lower part of the esophagus suggesting a possible eosinophilic esophagitis or caused by Candida. Despite the empirical initiated treatment, the patient's evolution was only slowly favorable. The histological exam established the diagnosis of HE. INTERVENTIONS We initiated acyclovir therapy with an outstandingly favorable evolution. OUTCOMES After 1 month, we detected the seroconversion of IgG anti-HSV. The patient's follow-up revealed no additional complaints. LESSONS Despite its rarity in immunocompetent individuals, HE must be taken into account even in otherwise healthy small children. Allergic conditions might represent a predisposing factor for HE.
Collapse
|
31
|
Altamimi EM, Alorjani MS, Alquran WY. Herpetic Esophagitis in Immunocompetent Child. Pediatr Gastroenterol Hepatol Nutr 2019; 22:298-302. [PMID: 31110963 PMCID: PMC6506431 DOI: 10.5223/pghn.2019.22.3.298] [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: 04/05/2018] [Revised: 05/10/2018] [Accepted: 05/16/2018] [Indexed: 11/14/2022] Open
Abstract
A previously healthy 2.5-year-old male child presented with vomiting, diarrhea, and fever. During hospitalization he developed odynophagia and refusal to eat. His symptoms did not respond to acid suppressant therapy. He underwent upper endoscopy which showed severe inflammation, ulcerations and abundant necrosis. Histopathological features and serological testing were consistent with herpetic esophagitis. He had no history of recurrent infections or history of sick contacts. His immunological work up showed normal level of immunoglobulins and his White Blood Cells subpopulations were normal. His HSV serology was positive. The patient was started on acyclovir 5 mg/kg q 8 hours. He resolved his symptoms within 24 hours of treatment.
Collapse
Affiliation(s)
- Eyad M Altamimi
- Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed S Alorjani
- Department of Pathology, Faculty of Medicine, Jordan University of science and Technology, Irbid, Jordan
| | - Wejdan Y Alquran
- Department of Pathology, Faculty of Medicine, Jordan University of science and Technology, Irbid, Jordan
| |
Collapse
|
32
|
Evaluation of Esophagitis Using Endoscopic Narrow Band Imaging. J Pediatr Gastroenterol Nutr 2018; 67:e123. [PMID: 28319605 DOI: 10.1097/mpg.0000000000001567] [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: 12/10/2022]
|
33
|
Hosomi S, Watanabe K, Nishida Y, Yamagami H, Yukawa T, Otani K, Nagami Y, Tanaka F, Taira K, Kamata N, Tanigawa T, Shiba M, Watanabe T, Nagahara H, Maeda K, Fujiwara Y. Combined Infection of Human Herpes Viruses: A Risk Factor for Subsequent Colectomy in Ulcerative Colitis. Inflamm Bowel Dis 2018; 24:1307-1315. [PMID: 29668948 DOI: 10.1093/ibd/izy005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the prevalence and pathogenicity of human herpes viruses except for cytomegalovirus (CMV) in patients with inflammatory bowel disease (IBD). The aim of this study was to determine the prevalence of human herpes viruses on colonic mucosa in patients with IBD and assess the long-term outcomes in these patients. METHODS We examined the colonic mucosal specimens from 66 patients with ulcerative colitis (UC), 54 patients with Crohn's disease (CD), and 29 healthy patients to identify the 6 most common types of human herpes virus, using multiplex polymerase chain reaction (PCR) technique. RESULTS Herpes simplex virus (HSV)-1/2 and varicella-zoster virus (VZV) were not detected in any of the groups. There was a higher prevalence of Epstein-Barr virus (EBV) (21.2%) and CMV (15.1%) in patients with UC than in patients with CD (EBV 9.3%, CMV 0%) and patents in the healthy control group (EBV 0%, CMV 3.4%). The prevalence of human herpes virus (HHV)-6A/B and HHV-7 was not statistically different among the groups. Five UC patients with inflammation had coexisting CMV and EBV or HHV-6. The combined infection of CMV with EBV or HHV-6 was a significant and independent prognostic factor for subsequent colectomy in patients with UC. CONCLUSIONS The increased prevalence of CMV coexisting with EBV/HHV-6 infection was associated with the clinical course in patients with UC. 10.1093/ibd/izy005_video1izy005_Video_15786489376001.
Collapse
Affiliation(s)
- Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Watanabe
- Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Hyogo, Japan
| | - Yu Nishida
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomomi Yukawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Nagahara
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Maeda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
34
|
Herpes Simplex Virus Esophagitis in Immunocompetent Children: A Harbinger of Eosinophilic Esophagitis? J Pediatr Gastroenterol Nutr 2018; 66:609-613. [PMID: 28937540 DOI: 10.1097/mpg.0000000000001748] [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] [Indexed: 12/13/2022]
Abstract
Herpes simplex virus (HSV) is a common cause of infectious esophagitis. The aim of this retrospective study is to identify comorbid and predisposing conditions and sequelae of HSV esophagitis in immunocompetent children. We reviewed 16 cases of HSV esophagitis diagnosed from January 1982 to March 2016. Five patients were immunosuppressed, 11 were immunocompetent and included in the study. Three (27%) had no other significant medical history. Five patients (45%) had repeat biopsies following their HSV infection, which showed eosinophilic infiltrate consistent with current diagnostic criteria of eosinophilic esophagitis (EoE), one of whom had known EoE. Environmental allergies and/or asthma were present in 4 of 5 of these patients. Among the immunocompetent patients, EoE was a comorbidity in almost half, although biopsies at the time of HSV esophagitis did not show diagnostic features of EoE. Clinical follow-up is therefore warranted for immunocompetent children presenting with HSV esophagitis, particularly those with atopic conditions.
Collapse
|
35
|
Yamada Y, Rodriguez C, Mannan AASR, Harrington M. Not so Obvious: Acute Herpes Esophagitis. Am J Med 2017; 130:1161-1162. [PMID: 28601544 DOI: 10.1016/j.amjmed.2017.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Yuji Yamada
- Department of Medicine, Mt Sinai Beth Israel Hospital, New York, NY.
| | - Carlos Rodriguez
- Department of Medicine, Mt Sinai Beth Israel Hospital, New York, NY
| | | | | |
Collapse
|
36
|
Lerner A, Arleevskaya M, Schmiedl A, Matthias T. Microbes and Viruses Are Bugging the Gut in Celiac Disease. Are They Friends or Foes? Front Microbiol 2017; 8:1392. [PMID: 28824555 PMCID: PMC5539691 DOI: 10.3389/fmicb.2017.01392] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022] Open
Abstract
The links between microorganisms/viruses and autoimmunity are complex and multidirectional. A huge number of studies demonstrated the triggering impact of microbes and viruses as the major environmental factors on the autoimmune and inflammatory diseases. However, growing evidences suggest that infectious agents can also play a protective role or even abrogate these processes. This protective crosstalk between microbes/viruses and us might represent a mutual beneficial equilibrium relationship between two cohabiting ecosystems. The protective pathways might involve post-translational modification of proteins, decreased intestinal permeability, Th1 to Th2 immune shift, induction of apoptosis, auto-aggressive cells relocation from the target organ, immunosuppressive extracellular vesicles and down regulation of auto-reactive cells by the microbial derived proteins. Our analysis demonstrates that the interaction of the microorganisms/viruses and celiac disease (CD) is always a set of multidirectional processes. A deeper inquiry into the CD interplay with Herpes viruses and Helicobacter pylori demonstrates that the role of these infections, suggested to be potential CD protectors, is not as controversial as for the other infectious agents. The outcome of these interactions might be due to a balance between these multidirectional processes.
Collapse
Affiliation(s)
- Aaron Lerner
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of TechnologyHaifa, Israel.,Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
| | - Marina Arleevskaya
- Central Research Laboratory, Kazan State Medical Academy KazanKazan, Russia
| | - Andreas Schmiedl
- Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
| | - Torsten Matthias
- Department of Research, AESKU.KIPP InstituteWendelsheim, Germany
| |
Collapse
|
37
|
Kunzmann AT, Graham S, McShane CM, Doyle J, Tommasino M, Johnston B, Jamison J, James JA, McManus D, Anderson LA. The prevalence of viral agents in esophageal adenocarcinoma and Barrett's esophagus: a systematic review. Eur J Gastroenterol Hepatol 2017; 29:817-825. [PMID: 28252462 DOI: 10.1097/meg.0000000000000868] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Human papilloma virus (HPV), which may reach the esophagus through orogenital transmission, has been postulated to be associated with esophageal adenocarcinoma (EAC). A systematic review of the literature investigating the prevalence of infectious agents in EAC and Barrett's esophagus (BE) was carried out. METHODS Using terms for viruses and EAC, the Medline, Embase, and Web of Science databases were systematically searched for studies published, in any language, until June 2016 that assessed the prevalence of viral agents in EAC or BE. Random-effects meta-analyses of proportions were carried out to calculate the pooled prevalence and 95% confidence intervals (CIs) of infections in EAC and BE. RESULTS A total of 30 studies were included. The pooled prevalence of HPV in EAC tumor samples was 13% (n=19 studies, 95% CI: 2-29%) and 26% (n=6 studies, 95% CI: 3-59%) in BE samples. HPV prevalence was higher in EAC tissue than in esophageal tissue from healthy controls (n=5 studies, pooled odds ratio=3.31, 95% CI: 1.15-9.50). The prevalence of Epstein-Barr virus (EBV) in EAC was 6% (n=5, 95% CI: 0-27%). Few studies have assessed other infectious agents. For each of the analyses, considerable between-study variation was observed (I=84-96%); however, sensitivity analyses did not show any major sources of heterogeneity. CONCLUSION The prevalence of HPV and EBV in EAC is low compared with other viral-associated cancers, but may have been hampered by small sample sizes and detection methods susceptible to fixation processes. Additional research with adequate sample sizes and high-quality detection methods is required.
Collapse
Affiliation(s)
- Andrew T Kunzmann
- aCancer Epidemiology and Health Services Research Group, Centre for Public Health bNorthern Ireland Biobank, Centre for Cancer Research and Cell Biology, Queens University Belfast cRoyal Victoria Hospital, Belfast Health and Social Care Trust dAntrim Area Hospital Laboratory, Department of Cellular Cytopathology and Molecular Pathology, Northern Health and Social Care Trust, Northern Ireland eInfections and Cancer Biology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Selhi PK, Tyagi R, Narang V, Midha V, Sandhu JS. Double trouble: Concomitant infection of esophagus by Herpes and Candida in diabetic, non HIV patients-Report of two cases. Diagn Cytopathol 2017; 45:631-633. [PMID: 28419774 DOI: 10.1002/dc.23731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - J S Sandhu
- Department of Nephrology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| |
Collapse
|
39
|
Infective oesophagitis: epidemiology, cause, diagnosis and treatment options. Curr Opin Otolaryngol Head Neck Surg 2016; 23:459-63. [PMID: 26371605 DOI: 10.1097/moo.0000000000000199] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent literature pertaining to infectious oesophagitis. RECENT FINDINGS Infectious oesophagitis is an uncommon condition of the oesophagus caused by viral, bacterial or fungal agents. A compromised immune system is the most important risk factor for the development of infectious oesophagitis and HIV or AIDS and solid organ transplant patients are particularly at risk. Common symptoms of infectious oesophagitis include odynophagia and dysphagia, but it can be difficult to distinguish infectious oesophagitis from other causes of oesophagitis based on patient symptoms alone. Definitive diagnosis requires esophagoscopy with biopsy for histologic and microbiologic evaluation. Endoscopic findings differ based on cause. Overall, Candida albicans is the most common cause of infectious oesophagitis. Treatment of infectious oesophagitis is based on host immune status, the severity of infection and risk of complications. When seemingly adequate treatment is unsuccessful, alternative diagnoses should be entertained and additional biopsies and/or diagnostics obtained. SUMMARY Recent research in infectious oesophagitis involves identifying preventive strategies for at-risk populations. Prevention may include use of probiotics, prophylactic medications and/or treatment of underlying immune dysfunction and could be important for susceptible individuals.
Collapse
|
40
|
Herpes Simplex Virus-2 Esophagitis in a Young Immunocompetent Adult. Case Rep Gastrointest Med 2016; 2016:7603484. [PMID: 27195158 PMCID: PMC4853934 DOI: 10.1155/2016/7603484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 03/30/2016] [Indexed: 01/07/2023] Open
Abstract
Herpes simplex esophagitis (HSE) is commonly identified in immunosuppressed patients. It is rare among immunocompetent patients and almost all of the reported cases are due to HSV-1 infection. HSV-2 esophagitis is extremely rare. We report the case of a young immunocompetent male who presented with dysphagia, odynophagia, and epigastric pain. Endoscopy showed multitudes of white nummular lesions in the distal esophagus initially suspected to be candida esophagitis. However, classic histopathological findings of multinucleated giant cells with eosinophilic intranuclear inclusions and positive HSV-2 IgM confirmed the diagnosis of HSV-2 esophagitis. The patient rapidly responded to acyclovir treatment. Although HSV-2 is predominantly associated with genital herpes, it can cause infections in other parts of the body previously attributed to only HSV-1 infection.
Collapse
|
41
|
Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis. ACG Case Rep J 2016; 3:165-8. [PMID: 27144193 PMCID: PMC4843145 DOI: 10.14309/crj.2016.38] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/15/2016] [Indexed: 12/18/2022] Open
Abstract
Herpes simplex esophagitis (HSE) is an acute, severe viral infection of the esophagus, rarely occurring in immunocompetent individuals. Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder. We recently observed 5 severe HSE cases in diagnosed EoE patients. Four of the 5 patients had active, untreated EoE at the time of infection, so HSE is not likely a side effect of swallowed topical corticosteroids, the first-line medical treatment of EoE. However, this coincidence of these 2 rare conditions raises the question of a causal relationship between these 2 forms of esophagitis, and whether active EoE might predispose to HSE infection.
Collapse
|
42
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Ahuja NK, Clarke JO. Evaluation and Management of Infectious Esophagitis in Immunocompromised and Immunocompetent Individuals. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2016; 14:28-38. [PMID: 26847359 DOI: 10.1007/s11938-016-0082-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Among the many inflammatory processes that may account for esophageal symptoms, infection represents an important etiologic category with numerous clinically relevant subdivisions. While features of the history and physical exam are informative, diagnosis often hinges on endoscopic visualization and histopathologic analysis. This chapter will review in series the most clinically relevant causative agents for infectious esophagitis, with specific diagnostic and therapeutic features of note divided into one of two immune milieus. Our discussion focuses primarily on Candida species, herpes simplex virus, and cytomegalovirus as the most common causes of infectious esophagitis while also addressing a number of less common pathogens worth keeping in mind.
Collapse
Affiliation(s)
- Nitin K Ahuja
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A Building, Room 344B, Baltimore, MD, 21224, USA
| | - John O Clarke
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, A Building, Room 344B, Baltimore, MD, 21224, USA.
| |
Collapse
|
44
|
Harris J, Smith T, Preis J. Intractable hiccups due to herpetic esophagitis in an immunocompromised patient. IDCases 2016; 4:34-7. [PMID: 27077025 PMCID: PMC4816903 DOI: 10.1016/j.idcr.2016.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/09/2016] [Indexed: 01/07/2023] Open
Abstract
Introduction Herpes 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. Case 68 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.
Collapse
Affiliation(s)
- John Harris
- SUNY/Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Tukisa Smith
- SUNY/Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Jana Preis
- SUNY/Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| |
Collapse
|
45
|
|
46
|
Fernández Morán M, Flórez Díez P, González Guerrero M, Jiménez Treviño S. Una rara causa de dolor abdominal en un niño sano. An Pediatr (Barc) 2015; 82:448-9. [DOI: 10.1016/j.anpedi.2015.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 02/18/2015] [Indexed: 11/30/2022] Open
|
47
|
Tang SJ, Wu R. Esophageal introitus (with videos). Gastrointest Endosc 2015; 81:270-81. [PMID: 25616751 DOI: 10.1016/j.gie.2014.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/29/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Shou-jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ruonan Wu
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
48
|
Noda J, Devlin S, Mahon GM, Zhu W. Case report: herpes simplex esophagitis in a frail elderly patient. J Am Med Dir Assoc 2014; 15:955-6. [PMID: 25441101 DOI: 10.1016/j.jamda.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Julio Noda
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Shannon Devlin
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Gerald M Mahon
- Division of Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, St Louis, Missouri
| | - Weigang Zhu
- Department of Pathology, DesPeres Hospital, St Louis, Missouri
| |
Collapse
|
49
|
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.
Collapse
|
50
|
Yap R, Leong T, Sweeney T. Herpes simplex gastritis causing pyloric stenosis. ANZ J Surg 2014; 86:614-6. [PMID: 24943386 DOI: 10.1111/ans.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Raymond Yap
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - Trishe Leong
- Department of Pathology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Tom Sweeney
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
| |
Collapse
|