A Rare Case of Herpes Esophagitis in an Immunocompetent Elderly Patient

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.

Keywords: acyclovir; elderly; family medicine; general medicine; herpes esophagitis; immunocompetent; rural hospital.

Figure 1. Computed tomography of the chest shows gas-accumulated lesions on the wall of the esophagus.

Figure 2. Upper gastrointestinal endoscopy reveals multiple round ulcers and erosions in the esophagus.

Figure 3. The histopathological finding of the edge of the ulcer shows giant cells with ground-glass nuclei and margination of the chromatin, indicating herpes virus infection (hematoxylin and eosin stain, A: ×40, B: ×400).

Figure 4. Blisters seen on the patient’s lower lip.

Figure 5. Follow-up of the upper gastrointestinal endoscopy shows the healed mucosa of the esophagus.