Acute herpetic esophagitis--a case report

Abstract

We report a case of acute herpetic esophagitis in a 33 year old man who was presumed to be immuno-compromised following prolonged steroid and cyclosporin treatment for acute rejection of a transplanted kidney. In Korea, all reported cases of herpetic esophagitis have been diagnosed in immuno-compromised and debilitated patients with a typical endoscopic appearance of ulcerating lesions. However, our patient showed multiple vesicular lesions without ulcer along the entire esophagus. The diagnosis was confirmed by colorimetric detection of herpes virus DNA using in situ hybridization. The endoscopic findings reported herein probably represent the typical early stage of acute herpetic esophagitis.

Fig. 1. 2.

Endoscopy revealed multiple, well-circumscribed vesicular eruptions scattered along the entire esophagus and the lesions varied in size from 0.3cm to 0.5cm in diameter. These vesicular lesions were dark red, not coalescent, and easily removable by biopsy forceps without remnant ulcer.

Fig. 1. 2.

Endoscopy revealed multiple, well-circumscribed vesicular eruptions scattered along the entire esophagus and the lesions varied in size from 0.3cm to 0.5cm in diameter. These vesicular lesions were dark red, not coalescent, and easily removable by biopsy forceps without remnant ulcer.

Fig. 3.

Light microscopy revealed multi-nucleated giant cells and Cowdry type A intranuclear inclusions (×400, HE stain).

Fig. 4.

In situ hybridization for type 1 herpes simplex virus gave positive signals as small dark red dots(× 100).