Acute Herpes Simplex Viral Esophagitis Occurring in 5 Immunocompetent Individuals With Eosinophilic Esophagitis

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.

Figure 1

Patient 2 endoscopy showing white exudates in the mid- and distal esophagus during episode of HSE.

Figure 2

Patient 2 esophageal biopsy showing (A) inflammation (fibrin and neutrophils) and squamous cells with nuclear HSV inclusions, few of them multinucleated, and (B) immunohistochemical staining with positive nuclei in squamous cells.

Figure 3

Patient 5 endoscopy showing (A) esophageal ulcurs during episode of HSE, and (B) slight edema of esophageal mucosa 2 months after resolution of HSE.