Herpes Simplex Virus Esophagitis in the Immunocompetent Host: An Overview

• Published in: The American journal of gastroenterology Vol. 95; no. 9; pp. 2171 - 2176
• Main Authors: Ramanathan, Jambunathan, Rammouni, Majed, Baran, Joseph, Khatib, Riad
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Oxford . 01.09.2000; Blackwell Publishing; Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
• Subjects: Acyclovir - therapeutic use; Antibodies, Viral - analysis; Antiviral Agents - therapeutic use; Biological and medical sciences; Biopsy; CD4-CD8 Ratio; Diagnosis, Differential; Esophagitis - drug therapy; Esophagitis - immunology; Esophagitis - virology; Esophagoscopy; Esophagus - virology; Gastroenterology; Herpes Simplex - drug therapy; Herpes Simplex - immunology; Herpes Simplex - virology; Herpesvirus 1, Human - immunology; Herpesvirus 1, Human - isolation & purification; Human viral diseases; Humans; Immunocompromised Host - immunology; Immunoglobulin G - immunology; Immunoglobulin M - immunology; Infectious diseases; Male; Medical sciences; Middle Aged; Retrospective Studies; Viral diseases; Viral diseases of the digestive system; Virus; Human; Symptomatology; Treatment; Herpesviridae; Alphaherpesvirinae; Esophageal disease; Esophagitis; Digestive diseases; Herpesvirus hominis; Diagnosis; Bibliographic review
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1111/j.1572-0241.2000.02299.x

The aim of this study was to delineate the characteristics of herpes simplex virus esophagitis (HSVE) in the immunocompetent host. The study entailed a case report and a review of relevant literature through a MEDLINE search back to 1966. All cases with documented HSVE in patients without immunosuppression were selected and their characteristics defined. A total of 38 cases were identified. The age range was 1–76 yr and the male/female ratio 3.2/1. Antecedent exposure to HSV disease was described in eight cases (21.1%). A prodrome of systemic manifestations preceded the onset of esophageal symptoms in nine subjects (23.6%). Manifestations included acute odynophagia (76.3%), heartburn (50%), and fever (44.7%). Concurrent oropharyngeal lesions were uncommon (n = 8, 21.1%). Endoscopically, extensive involvement was common, showing friable mucosa (84.2%), numerous ulcers (86.8%), and whitish-exudates (39.5%). The distal esophagus was most commonly affected (63.8%). Microscopic examination showed characteristic viral cytopathology in 26 (68.4%) cases. Virus was recovered from esophageal-brushes or biopsies in 23 of 24 (95.8%) patients and immunocytochemistry was positive in seven of eight (87.5%) cases. Immune status was consistent with primary HSV infection in eight (21.1%) cases. The disease was self-limiting, although esophageal perforation and upper GI bleeding were reported in one case each. HSVE in the immunocompetent host is a rare but distinct entity, and is significantly more common in male subjects. It represents either primary infection or reactivation, and is characterized by acute onset, systemic manifestations, and extensive erosive-ulcerative involvement of the mid-distal esophagus. Histopathological examination alone may miss the diagnosis; adding tissue-viral culture optimizes the diagnostic sensitivity. It is usually self-limiting; whether antiviral therapy is beneficial remains unknown.