HSV Esophagitis in an Immunocompetent 17-Year-Old

An AI-assisted morphoproteomic approach is a supportive tool in esophagitis-related precision medicine

Esophagitis is a frequent, but at the molecular level poorly characterized condition with diverse underlying etiologies and treatments. Correct diagnosis can be challenging due to partially overlapping histological features. By proteomic profiling of routine diagnostic FFPE biopsy specimens (n = 55) representing controls, Reflux- (GERD), Eosinophilic-(EoE), Crohn's-(CD), Herpes simplex (HSV) and Candida (CA)-esophagitis by LC-MS/MS (DIA), we identified distinct signatures and functional networks (e.g. mitochondrial translation (EoE), immunoproteasome, complement and coagulations system (CD), ribosomal biogenesis (GERD)), and pathogen-specific proteins for HSV and CA. Moreover, combining these signatures with histological parameters in a machine learning model achieved high diagnostic accuracy (100% training set, 93.8% test set), and supported diagnostic decisions in borderline/challenging cases. Applied to a young patient representing a use case, the external GERD diagnosis could be revised to CD and ICAM1 was identified as highly abundant therapeutic target. This resulted in CyclosporinA as a personalized treatment recommendation by the local multidisciplinary molecular inflammation board. Our integrated AI-assisted morphoproteomic approach allows deeper insights in disease-specific molecular alterations and represents a promising tool in esophagitis-related precision medicine.

A Rare Finding of Herpes Simplex Virus Esophagitis Concomitant With Duodenitis in an Immunocompetent Host

Herpes simplex virus (HSV) esophagitis and duodenitis are well-known features of herpes virus reactivation in immunosuppressed patients. We discuss the case of HSV esophagitis concomitant with duodenitis in an immunocompetent individual. A 77-year-old male patient, previously healthy, was found to have on upper endoscopy several ulcers in the esophagus and second portion of the duodenum. A diagnosis of HSV esophagitis concomitant with duodenitis was made. The patient was started on intravenous acyclovir, and 48 hours after treatment, his symptoms significantly improved. He was then discharged on acyclovir per os for a total of 14 days. Endoscopy 1 month later showed complete resolution of both esophageal and duodenal ulcers. Physicians should keep the diagnosis of HSV esophagitis with duodenitis in the differentials in the setting of odynophagia, dysphagia, and epigastric pain, even in the case of an immunocompetent individual. Further research is needed to strengthen the literature on this topic.

Herpes Simplex Virus Esophagitis in an Immunocompetent Patient: A Case Report

Even though it is rare, herpes simplex virus (HSV) esophagitis has a significant adverse impact on immunocompromised people, such as those with HIV, cancer patients receiving chemotherapy or radiation to the neck, and recipients of transplants receiving immunosuppressive treatments. This makes a high level of clinical suspicion necessary for a precise diagnosis and successful treatment. Although rare, its occurrence in immunocompetent patients poses unique challenges for diagnosis and therapy. A 68-year-old woman with HSV esophagitis presented with severe symptoms, including odynophagia and hematemesis. Endoscopy revealed "volcano-like" ulcers; after confirmation of HSV-1 infection, treatment with acyclovir, esomeprazole, and sucralfate led to symptom resolution within a week and complete healing in three months. This case underscores the importance of considering HSV esophagitis in the differential diagnosis of esophageal ulcers in immunocompetent patients, emphasizing the need for early diagnosis and antiviral therapy for effective treatment.

Herpes Simplex Virus Esophagitis in an Immunocompetent Patient

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.