Initial presentation for herpes esophagitis (HE) is non-specific. The prodromal stage may mimic the common flu and includes a fever of about 39°C, malaise, reduction in weight, as well as pulmonary symptoms and sore throat. After flu-like symptoms, patients develop esophageal signs specifically, acute odynophagia, dysphagia for both fluids and solid foods, retrosternal pain, nausea and subsequent vomiting [1] [2]. Symptoms for immunocompetent subjects can be self-limiting thus hindering the process of diagnosis. Furthermore, prodromal symptoms of herpes esophagitis in immunocompetent patients may be absent and manifest as acute odynophagia and dysphagia. In some cases, the infection is mild in character or even asymptomatic [3].

HSV-specific signs such as oropharyngeal (herpes labialis) and genital lesions are not commonly concurrent with esophagitis but are described in about 20% of cases [4]. Herpes lesions may herald esophagitis, or may arise after esophagitis or may be absent [3] [4] [5].

Specifics of history data are important to exclude collateral immunological conditions and possible HIV infection. On the grounds that herpes esophagitis is an opportunistic infection, subjects prone to developing it are either immunocompromised or are taking immunosuppressive medications. For example, a patient with a chronic autoimmune disease takes systemic corticosteroids that act on suppressing the immune system [2] [4] [5]. Gastro-esophageal reflux disease (GERD) patients and radiation therapy participants should be considered at risk of developing HE. Those receiving chemotherapy and transplant recipients are also at high risk. Cases of patients with HE and prior nasogastric intubation are reported, So, history of surgical procedures and previous inpatient care should be obtained [3].

• Pain

  We present a case of herpes esophagitis after corticosteroid treatment for back pain including epidural steroid injections. Corticosteroids, especially local injections, are a common treatment for chronic back pain, but they are not without risk. [ncbi.nlm.nih.gov]

  Over-the-counter pain relievers may help ease the pain. [healthline.com]

  These small sores and subsequent inflammation make it difficult and painful for patients to swallow. In severe cases, patients can experience weight loss because it becomes too painful to eat normal meals. [wisegeekhealth.com]

  Pain in throat and below the breastbone while swallowing. Pain persists throughout the day. Patient feels as if something is stuck up in throat and middle of chest. Due to less intake of food, patient losses weight. Fever. General debility. [tandurust.com]

  People with herpes esophagitis experience pain with eating and trouble swallowing. [en.wikipedia.org]

• Fever

  Outbreaks can be triggered by stress, acute illness, certain medications, fever, excess sunlight and the onset of menstruation in women. Related wiseGEEK Articles [wisegeekhealth.com]

  A review of the literature revealed 21 other cases in immunocompetent adults; and, of these 21 patients, odynophagia was noted in 19, nine experienced fever, and oral lesions were found in five of these individuals. [ncbi.nlm.nih.gov]

• Inflammation

  Herpes esophagitis is an infectious inflammation of esophagus caused by two members of herpesvirus family, herpes simplex virus HSV-1 or HSV-2. [symptoma.com]

  Endoscopic findings included non-specific inflammation, discrete ulcers, coalescent ulcers, and pseudomembranous esophagitis. Herpes virus was not suspected endoscopically as the cause of esophagitis in 30% of cases. [mayoclinic.pure.elsevier.com]

  Allergies Corticosteroids: These oral medications can reduce allergy-related inflammation, resulting in less inflammation in the esophagus, allowing it to heal. [medicalnewstoday.com]

  Endoscopic findings included nonspecific inflammation, discrete ulcers, coalescent ulcers, and pseudomembranous esophagitis. Herpes virus was not suspected endoscopically as the cause of esophagitis in 30% of cases. [ncbi.nlm.nih.gov]

• Asymptomatic

  A case report: asymptomatic esophageal eosinophilia after herpes simplex esophagitis. [reed.es]

  In some cases, the infection is mild in character or even asymptomatic. HSV-specific signs such as oropharyngeal (herpes labialis) and genital lesions are not commonly concurrent with esophagitis but are described in about 20% of cases. [symptoma.com]

  Primary infection Asymptomatic in two-thirds of both HSV-1 and 2. Most HSV is acquired from an infected but asymptomatic person. [hopkinsguides.com]

  In fatal cases the brain shows asymptomatic necrosis particularly prominent in the temporal lobes but also involving the hippocampus and the posterior occipital cortex. Hemorrhage may be prominent. [histopathology-india.net]

• Malaise

  The prodromal stage may mimic the common flu and includes a fever of about 39°C, malaise, reduction in weight, as well as pulmonary symptoms and sore throat. [symptoma.com]

  Primary infection may also be associated with systemic symptoms, such as fever and malaise. In general, the severity of symptoms and the number of lesions is considerably less with reactivation. (See 'Recurrent infection' below.) [uptodate.com]

  Other signs of infection may include: joint pain chills fever general malaise (not feeling well) Your doctor will ask you about your medical history. They may also look into your esophagus with a small, lighted camera, called an endoscope. [healthline.com]

  Fever with chills Pain in the joints Weakness and malaise How Do You Get Herpes In Esophagus? Herpes of the esophagus is caused by the HSV 1 and is the same virus which causes cold sores. It is communicated via mouth to mouth contact. [simple-remedies.com]

• Odynophagia

  It is important to remind herpes esophagitis in cases of severe odynophagia even in immunocompetent hosts. [ncbi.nlm.nih.gov]

  She also reported odynophagia, nausea immediately after eating, and reports that she has lost ten pounds. [shmabstracts.com]

  Herpetic ulcers in the esophagus of a 31 year old man with AIDS who presented with odynophagia and dysphagia. Symptoms responded to antiviral therapy. [endoatlas.com]

  After flu-like symptoms, patients develop esophageal signs specifically, acute odynophagia, dysphagia for both fluids and solid foods, retrosternal pain, nausea and subsequent vomiting. [symptoma.com]

• Dysphagia

  Patients with esophagitis will describe odynophagia, or pain with swallowing, however they may report esophageal dysphagia as well. [shmabstracts.com]

  Herpetic ulcers in the esophagus of a 31 year old man with AIDS who presented with odynophagia and dysphagia. Symptoms responded to antiviral therapy. [endoatlas.com]

  A 19-year-old white woman presented with a 6-month history of progressively worsening dysphagia. [ncbi.nlm.nih.gov]

  After flu-like symptoms, patients develop esophageal signs specifically, acute odynophagia, dysphagia for both fluids and solid foods, retrosternal pain, nausea and subsequent vomiting. [symptoma.com]

• Nausea

  The unexpected diagnosis of herpetic esophagitis in a patient with nausea led us to review our experience with this disease. [mayoclinic.pure.elsevier.com]

  Abstract The unexpected diagnosis of herpetic esophagitis in a patient with nausea led us to review our experience with this disease. [ncbi.nlm.nih.gov]

  Figure 1 A 47-year-old woman with a history of hypertension and alcohol abuse had had fatigue, nausea, vomiting, and abdominal pain for two days. On admission, she vomited coffee-grounds material. [nejm.org]

  After flu-like symptoms, patients develop esophageal signs specifically, acute odynophagia, dysphagia for both fluids and solid foods, retrosternal pain, nausea and subsequent vomiting. [symptoma.com]

• Vomiting

  Figure 1 A 47-year-old woman with a history of hypertension and alcohol abuse had had fatigue, nausea, vomiting, and abdominal pain for two days. On admission, she vomited coffee-grounds material. [nejm.org]

  It is recognized that upper GI tract series are useful in the evaluation of vomiting to screen for possible anatomic abnormalities of the upper GI tract. 4 For example, in infants with bilious vomiting, an upper GI tract series may be useful for evaluating [pediatrics.aappublications.org]

  After flu-like symptoms, patients develop esophageal signs specifically, acute odynophagia, dysphagia for both fluids and solid foods, retrosternal pain, nausea and subsequent vomiting. [symptoma.com]

  Irritation leading to esophagitis may be caused by any of the following: GERD, or gastroesophageal reflux disease Vomiting Surgery Medications such as aspirin and other anti-inflammatory drugs Taking a large pill with too little water or just before bedtime [webmd.com]

• Aphthous Stomatitis

  Physical exam was significant for cachexia, temporal wasting, aphthous stomatitis involving the tongue and diffuse abdominal tenderness. [ncbi.nlm.nih.gov]

• Chest Pain

  Odynophagia and chest pain were each present in half of the cases, but 26% of patients had neither. Gastrointestinal bleeding was attributable to herpetic esophagitis in 30%. [mayoclinic.pure.elsevier.com]

  Patients typically present with acute odynophagia with severe substernal chest pain during swallowing. Dysphagia, chest pain, and upper gastrointestinal bleeding are less often observed. [med-ed.virginia.edu]

• Retrosternal Chest Pain

  The most common clinical manifestations were odynophagia (60.7%), fever (51.8%), and retrosternal chest pain (46.4%). [ncbi.nlm.nih.gov]

  Esophageal involvement occurs by contact of HSV in saliva. [2] Common clinical manifestations of HSV esophagitis are odynophagia (60.7%), fever (51.8%), and retrosternal chest pain (46.4%). [1] The duration of symptoms is usually Characteristic endoscopic [jdeonline.in]

  Usually, the main complaints of HE are reported as fever and appetite loss, with retrosternal chest pain due to esophageal stenosis secondary to mucosal edema, especially in cases of immunodeficiency. 3, 9, 10 Although there were no stenotic lesions or [dovepress.com]

• Hypotension

  Signs of sepsis may also be present, including hypotension, metabolic acidosis, and disseminated intravascular coagulopathy (DIC), all of which are associated with increased mortality ( 29 ). [antimicrobe.org]

• Blister

  The blisters failed to improve with a 2-week prednisone taper completed 1 month prior to presentation. The patient was not currently taking any other medications. He had a remote history of fever blisters but no other dermatologic issues. [mdedge.com]

  Mouth and lip ulcers, also known as canker sores, cold sores or fever blisters, may also be present in patients with esophagitis. These ulcers are painful open sores that can make eating and drinking difficult. [wisegeekhealth.com]

  The tiny lesions of fluid filled blisters and open sores also spread to the throat, mouth and corners of lips. Besides the local symptoms, patient may also suffer from systemic symptoms. Below are important symptoms of herpes esophagitis. [tandurust.com]

  I started getting fever blisters decades ago. Classic cold sores. Once every three or five years. So, I knew I had HSV-1 orally. Fast forward 30 years and I get genital herpes...weird symptoms with a delayed primary OB. [honeycomb.click]

  Computer virus could cause blisters during the oral cavity or vaginal say, but then HSV-2 an average of influences yet the genitals, whereas HSV-1 mostly influences yet the oral cavity. [lyndsaylondon.com]

When evaluating herpes esophagitis, radiological examination is inferior to endoscopy as HE findings are not specific for this type of disorder. Misdiagnosis as fungal esophagitis is a common error because this condition also presents with large lesions.

Endoscopy is necessary for both the examination of the esophagus and obtaining a biopsy specimen to confirm the diagnosis. In the early stage of HE, the macroscopic examination may reveal diffuse ulcerations with central depressions (volcano-like) that are yellow-white in color and variable in size. Edematous halo and white exudate can also be present. Subsequently, lesions may consolidate [6]. Most common site of ulcerations in infectious esophagitis is the lower third of the esophagus, although cases of the middle third and ulcerations throughout the esophagus are also present. Occurrence in upper third is less likely [3] [5]. The tendency to form superficial ulcers may be the characteristic feature distinguishing HE from esophagitis caused by cytomegalovirus (CMV), which in contrast is associated with deep ulcerations.

Biopsy analysis is imperative for correct diagnosis. The histological specimen of mucosa must be collected from margins of the ulcer. Microscopy will reveal a unique picture of herpes infection like acute inflammation, multinucleated giant cells with ground glass nuclei, as well as eosinophilic inclusions in the nuclei [2] [7]. Immunohistochemistry is also necessary to confirm the presence of HSV antigens [8].

Virus isolation and cell culture along with polymerase chain reaction (PCR) are also beneficial in confirming the diagnosis [9].

• Candida

  Two examples of advanced Candida esophagitis demonstrate a shaggy esophagus. [emedicine.medscape.com]

  Upper endoscopy revealed severe esophagitis, and biopsies found evidence of herpes and candida. [shmabstracts.com]

  The aim of this study was to determine the etiology of Candida esophagitis in our medical centre over an 18-month period. Additionally, we aimed to investigate predisposing conditions for esophageal candidosis caused by different Candida species. [scienceopen.com]

  Candida esophgitis : Candida is the most common cause of infectious esophagitis. C. albicans is the most common organism, but it can also be attributed to C. tropicalis, C. pseduotropicalis, and c. kruzei. [med-ed.virginia.edu]

  […] cytomegalovirus (CMV), herpes simples virus (HSV) and Mycobacterium-avium intracellulare (MAI) HIV (idiopathic) esophagitis may be the cause if no other pathogens are found Clinical Findings Dysphasia and odynophagia are common symptoms with advanced HIV Candida [learningradiology.com]

• Viral Inclusion Body

  Diagnosis of herpes simplex esophagitis (HSE) was established through histological analysis showing squamous epithelial cells with viral-inclusion-bodies, immunohistochemically positive for HSV (Figure 2). [acgcasereports.gi.org]

  In a small review of 38 cases of immunocompetent individuals with HSE, microscopic findings consistent with acute and chronic inflammation were present, along with cytopathologic changes and viral inclusion bodies consistent with herpetic infection were [ncbi.nlm.nih.gov]

We present a case of herpes esophagitis after corticosteroid treatment for back pain including epidural steroid injections. Corticosteroids, especially local injections, are a common treatment for chronic back pain, but they are not without risk. [ncbi.nlm.nih.gov]

The main aim of treatment is to alleviate symptoms and reduce the recurrence of episodes. Treatment of herpes esophagitis consists of anti viral drugs. Painkillers may be needed to alleviate pain and inflammation. [tandurust.com]

Infection of the esophagus by the herpes simplex virus is rare in people with normal immune systems and usually runs its course without treatment. [lutheranhealthcare.org]

Fluoroscopy On double contrast studies, it manifests as multiple small ( Treatment and prognosis It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment 1. [radiopaedia.org]

Prognosis is fairly good; and most people with herpes of the esophagus don’t seem to have any serious long-term health issues. [simple-remedies.com]

The prognosis is good with rapid diagnosis and proper treatment. Ultimately, the prognosis depends on the underlying disease process. (See Prognosis .) The history findings vary based on the type of esophagitis (eg, reflux or infectious). [emedicine.medscape.com]

Prognosis for esophagitis is normally good. Esophagitis can be caused by certain allergies. Being overweight increases the risk of esophagitis. Depending on the cause of esophagitis, there are various possible treatments. [medicalnewstoday.com]

Prognosis Almost all cases of esophagitis can be cured. Some causes, such as acid reflux, may require long-term treatment. [health.harvard.edu]

Although herpes simplex virus is a recognized cause of esophagitis in immunocompromised patients, it may also be the etiologic agent in otherwise healthy individuals. Odynophagia and dysphagia are the major symptoms. [ncbi.nlm.nih.gov]

The etiological agent is the herpes simplex virus (HSV), which is a double-stranded DNA virus classified into two subtypes: HSV-1 and HSV-2. [radiopaedia.org]

Viral tissue culture represents the most accurate means of diagnosing the precise etiology. [ipfs.io]

General Usually immunodeficient. [1] Etiology: Herpes simplex virus. Gross/endoscopic Features: Ulcers with a "punched-out" appearance with a brown/red edge. Images Herpes esophagitis - endoscopy. (WC) www: Herpes esophagitis - gross (utah.edu). [librepathology.org]

[…] counts less than 200 cells/mm 3 CMV and idiopathic HIV ulcers usually occur with CD4 counts less than 200 Acute onset of symptoms is most common Large, flat ulcers >1cm Imaging Findings Endoscopy with biopsy is the best method of establishing a specific etiology [learningradiology.com]

Surgical Pathology of the Gastrointestinal System: Bacterial, Fungal, Viral, and Parasitic Infections provides pertinent clinical, diagnostic, and epidemiologic information that will be valuable to the practicing surgical pathologist. [books.google.com]

Many such techniques remain limited to research or epidemiologic use and are not typically available in the clinical laboratory. [ncbi.nlm.nih.gov]

Pathophysiology The major pathophysiologic disturbance in scleroderma is the overproduction and deposition of cellular matrix proteins such as collagen, fibronectin, tenascin, fibrillin-1, and glycosaminoglycans, into affected organs, predominantly the [nature.com]

Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 46. Updated by: Jatin M. [medlineplus.gov]

We give here an extensive review of HE, including its pathophysiology, clinical manifestations, treatment and outcome. [onlinelibrary.wiley.com]

Pathophysiology The pathophysiology of esophagitis depends on its etiology (see Etiology ). [emedicine.medscape.com]

Seite 290 - Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: A meta-analysis. Hepatology 1999; 29: 1655-61 6. ‎ [books.google.de]

A herpes esophagitis infection is particularly alarming because most healthy immune systems prevent the virus from showing symptoms in the throat. [stdaware.com]

Suppression of HIV with antiretroviral medications, careful monitoring of immunosuppressive medications are important means of prevention. Antiviral prophylaxis such as daily acyclovir in immunocompromised individuals may be considered. [en.wikipedia.org]

and (3) prevention of organ damage caused by the ongoing tissue remodeling. [karger.com]

Prevention Herpes simplex virus is commonly found in humans, yet uncommonly results in systemic manifestations. [ipfs.io]

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2. Marinho AV, Bonfim VM, Rodrigues de Alencar L, Pinto SA, de Araújo Filho JA. Herpetic Esophagitis in Immunocompetent Medical Student. Case Reports in Infectious Diseases. 2014. Article ID 930459.
3. Généreau T, Rozenberg F, Bouchaud O, Marche C, Lortholary O. Herpes esophagitis: a comprehensive review. Clin Microbiol Infect. 1997 Aug;3(4):397-407.
4. Ramanathan J, Rammouni M, Baran J, Khatib R. Herpes simplex virus esophagitis in the immunocompetent host: an overview. Herpes Simplex Virus Esophagitis in Immunocompetent Host.Am J Gastroenterol. 2000 Sep;95(9):2171-6.
5. Geraci G, Pisello F, Modica G, Li Volsi F, Cajozzo M, Sciumè C. Herpes Simplex Esophagitis in Immunocompetent Host: A Case Report. Diagnostic and Therapeutic Endoscopy 2009. Article ID 717183.
6. Lee B, Caddy G. A rare cause of dysphagia: Herpes simplex esophagitis. World Journal of Gastroenterology : WJG. 2007;13(19):2756-2757.
7. Eymard D, Martin L, Doummar G, Piché J. Herpes simplex esophagitis in immunocompetent hosts. The Canadian Journal of Infectious Diseases. 1997;8(6):351-353.
8. Yousufa T, Khana A, Wanga S, Blumensteinb B. Herpes Esophagitis in an Immunocompetent Teenager. J Med Cases. April 2015;6(4):173-175.
9. Bansal RK, Ranjan P. Herpetic esophagitis: An uncommon cause of dysphagia. J Dig Endosc 2014;5:119-20.