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].

• 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]

• 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]

• Melena

  A 54-year-old man with a history of well-controlled schizophrenia and living in an assisted-living facility for the mentally ill was admitted to the hospital because of coffee-ground emesis and melena. [doi.org]

  […] tachycardia Vomit blood, have bloody stools or dark sticky, foul-smelling stools PUD (includes gastric and duodenal ulcers) Gnawing or burning pain in the epigastrium Bleeding that may result in anemia, weakness, and fatigue Hematemesis, hematochezia, or melena [atsu.edu]

• 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]

• Hypertension

  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]

  Most common drugs for these people *: Zolpidem: 4 people, 100.00% Xylocaine: 4 people, 100.00% Viagra: 4 people, 100.00% Deca-Durabolin: 4 people, 100.00% Betadine: 4 people, 100.00% Aldara: 4 people, 100.00% Top symptoms for these people *: Portal Hypertension [ehealthme.com]

  Case report A 68 year old African American male with a history of hypertension, end-stage renal disease and multiple myeloma presented to the emergency department for evaluation of recurrent coffee ground emesis associated with chronic hiccups of ten [ncbi.nlm.nih.gov]

• Irritability

  Effects from Herpes Esophagitis include: irritation and inflammation of the throat tearing of the esophagus and throat tissue irritation while swallowing general throat and chest pain Causes Of Herpes Esophagitis Herpes Esophagitis can be caused by either [stdaware.com]

  The most common cause of swelling and irritation of the esophagus is stomach acid that flows back into your esophagus. But infections can also cause this swelling and irritation. [hopkinsmedicine.org]

  Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi, or diseases that weaken the immune system. Infections that cause esophagitis include: Candida. [webmd.com]

  GERD can irritate the esophagus, leading to esophagitis. Allergies Certain allergies can cause eosinophilic esophagitis, triggered by an allergic reaction. Eosinophils are a type of white blood cell. [medicalnewstoday.com]

  WebMD talks about either a creates only to cures of esophagitis, that an irritation of them esophagus. Herpes. Need fungi, such an viral poor health can form during the esophagus the minute your body’s defense mechanisms will become weakened. [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].

• Esophageal Motility Disorder

  Thus, at-risk patients include those with AIDS, organ transplants, alcoholism, diabetes, undernutrition, cancer, and esophageal motility disorders. Candida infection may occur in any of these patients. [merckmanuals.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.
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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.