de Choudens FCR, Sethi S, Pandya S, Nanjappa S, Greene JN. Atypical manifestation of herpes esophagitis in an immunocompetent patient: Case report and literature review. World J Clin Infect Dis 2017; 7(3): 46-49 [DOI: 10.5495/wjcid.v7.i3.46]
Corresponding Author of This Article
Fabiola C Rios de Choudens, MD, Resident Physician, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 17 Davis Blvd, Suite 308, Tampa, FL 33606, United States. friosdechoudens@health.usf.edu
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Infect Dis. Aug 25, 2017; 7(3): 46-49 Published online Aug 25, 2017. doi: 10.5495/wjcid.v7.i3.46
Atypical manifestation of herpes esophagitis in an immunocompetent patient: Case report and literature review
Fabiola C Rios de Choudens, Sajiv Sethi, Shuchi Pandya, Sowmya Nanjappa, John N Greene
Fabiola C Rios de Choudens, Sajiv Sethi, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33606, United States
Shuchi Pandya, Department of Infectious Disease, University of South Florida, Tampa, FL 33606, United States
Sowmya Nanjappa, Department of Internal Hospital Medicine, Department of Oncologic Sciences, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612-9416, United States
John N Greene, Department of Internal Hospital Medicine, Moffitt Cancer Center and Research Institute, Tampa, FL 33612-9497, United States
Author contributions: All authors contributed to this paper.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of South Florida and the Moffitt Cancer Center Institutional Review Board.
Informed consent statement: The patient involved in this study gave written informed consent authorizing use and disclosure of her protected health information. A PDF file of disclosure documents is included.
Conflict-of-interest statement: None of the authors have any funding or conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fabiola C Rios de Choudens, MD, Resident Physician, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 17 Davis Blvd, Suite 308, Tampa, FL 33606, United States. friosdechoudens@health.usf.edu
Telephone: +1-787-2388628 Fax: +1-813-2590697
Received: March 30, 2017 Peer-review started: March 31, 2017 First decision: May 8, 2017 Revised: July 9, 2017 Accepted: July 21, 2017 Article in press: July 23, 2017 Published online: August 25, 2017 Processing time: 148 Days and 4.3 Hours
Abstract
Herpes simplex virus (HSV) is known to cause esophagitis in immunosuppressed patients; however, it is rarely seen in immunocompetent patients. We present a unique case of HSV esophagitis in a healthy male, without any immunocompromising conditions or significant comorbidities. The patient presented with a two-week history of dysphagia, odynophagia and epigastric pain. Physical exam revealed oral hyperemia without any visible ulcers or vesicles. He underwent esophagogastroduodenoscopy which noted severe esophagitis with ulceration. Esophageal biopsies were positive for HSV. Serology was positive for HSV as well. After initiating treatment with Famciclovir 250 mg 3 times/d, high dose proton pump inhibitor and sucralfate, patient had complete resolution of symptoms at his 2.5 wk follow up appointment. Subsequent workup did not reveal any underlying immune disorders. While HSV is a known causative of esophagitis in the immunocompromised, its presentation in healthy patients without any significant comorbidity is uncommon. Presentation with a systemic viral prodrome further makes this case unique.
Core tip: Herpes simplex virus (HSV) is known to cause esophagitis in immunosuppressed patients but rarely does it cause esophagitis in immunocompetent patients. We present a unique case of a healthy 43-year-old man who presented with two week course of dysphagia, odynophagia, and epigastric pain. Work up, which included esophagogastroduodenoscopy, revealed severe esophagitis with ulceration and biopsies showed HSV. He was successfully treated with famciclovir.
