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DOI: 10.1055/s-2007-995380
© Georg Thieme Verlag KG Stuttgart · New York
Herpes simplex virus esophagitis in an immunodeficient patient with non-small-cell lung cancer following a disseminated herpes zoster infection
F. Gundling, MD
Department of Gastroenterology, Hepatology and Gastrointestinal Oncology
Bogenhausen Academic Teaching Hospital
Technical University of Munich
Englschalkinger Straße 77
81925 Munich
Germany
Fax: +49-89-92702486
Email: Gastroenterologie@kh-bogenhausen.de
Publication History
Publication Date:
30 July 2008 (online)
Herpes simplex virus (HSV) esophagitis is rare. It usually occurs in the setting of immunodeficiency, for example in patients with malignancy [1], patients on immunosuppressive therapy [2], or patients with AIDS [3].
A 62-year-old patient with non-small-cell lung cancer (T3N2M1) presented with a 1-month history of persistent dysphagia and odynophagia. Eight weeks before, he had undergone whole-brain radiation therapy for multiple cerebral metastases. A few days later, the patient developed disseminated herpes zoster, secondary to the immunosuppression caused by the radiation. He received systemic therapy with intravenous aciclovir (10 mg/kg per day) for 14 days, resulting in complete recovery of the skin lesions.
Upper gastrointestinal endoscopy revealed numerous, coin-shaped, white pseudomembranous lesions, 1 – 2 cm in diameter, with a discrete central ulcer in the proximal portion of the esophagus which bled readily ([Fig. 1]). The stomach and duodenum were normal. Herpes virus infection was not suspected as the cause of the esophagitis at endoscopy. However, biopsy specimens showed typical herpetic histological changes, including a ground-glass appearance of the nuclear chromatin, nuclear inclusions, and multinucleation ([Fig. 2]), and positive immunostaining with specific anti-HSV type 1 antibodies ([Fig. 3]), appearances supporting the diagnosis of herpetic esophagitis.
Because inflammatory parameters were not significantly elevated and because the patient showed no signs of systemic herpes virus infection or relapse of herpes zoster, he was not given antiviral chemotherapy. A repeat endoscopy 2 weeks later showed a marked spontaneous improvement and the patient’s initial symptoms had resolved. To date, the HSV esophagitis has not relapsed (after 3 months).
Proper endoscopic interpretation is a prerequisite for the recognition of herpes esophagitis because biopsy and culture results can be negative in the early stages of this condition [4]. However, failure to diagnose HSV esophagitis can result in gastrointestinal bleeding caused by herpetic esophageal ulcers [5]. We conclude that physicians who are treating patients with malignancies should be aware of the potential of patients to develop HSV esophagitis, especially as effective antiviral agents are now available.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AZ
#References
- 1 Matsumoto J, Sumiyoshi A. Herpes simplex esophagitis: a rare study in autopsy series. Am J Clin Pathol. 1985; 84 96-99
- 2 McDonald D B, Sharma P, Hackman R C. et al . Esophageal infections in immunosuppressed patients after bone marrow transplantation. Gastroenterology. 1985; 88 1111-1117
- 3 Wilcox C M, Schwartz D A, Clark W S. Esophageal ulceration in human immunodeficiency virus infection: causes, response to therapy, and long-term outcome. Ann Intern Med. 1995; 122 143-149
- 4 Kadakia S C, Oliver G A, Peura D A. Acyclovir in endoscopically presumed viral esophagitis. Gastrointest Endosc. 1987; 33 33-35
- 5 Rattner H M, Cooper D J, Zaman M B. Severe bleeding from herpes esophagitis. Am J Gastroenterol. 1985; 80 523-525
F. Gundling, MD
Department of Gastroenterology, Hepatology and Gastrointestinal Oncology
Bogenhausen Academic Teaching Hospital
Technical University of Munich
Englschalkinger Straße 77
81925 Munich
Germany
Fax: +49-89-92702486
Email: Gastroenterologie@kh-bogenhausen.de
References
- 1 Matsumoto J, Sumiyoshi A. Herpes simplex esophagitis: a rare study in autopsy series. Am J Clin Pathol. 1985; 84 96-99
- 2 McDonald D B, Sharma P, Hackman R C. et al . Esophageal infections in immunosuppressed patients after bone marrow transplantation. Gastroenterology. 1985; 88 1111-1117
- 3 Wilcox C M, Schwartz D A, Clark W S. Esophageal ulceration in human immunodeficiency virus infection: causes, response to therapy, and long-term outcome. Ann Intern Med. 1995; 122 143-149
- 4 Kadakia S C, Oliver G A, Peura D A. Acyclovir in endoscopically presumed viral esophagitis. Gastrointest Endosc. 1987; 33 33-35
- 5 Rattner H M, Cooper D J, Zaman M B. Severe bleeding from herpes esophagitis. Am J Gastroenterol. 1985; 80 523-525
F. Gundling, MD
Department of Gastroenterology, Hepatology and Gastrointestinal Oncology
Bogenhausen Academic Teaching Hospital
Technical University of Munich
Englschalkinger Straße 77
81925 Munich
Germany
Fax: +49-89-92702486
Email: Gastroenterologie@kh-bogenhausen.de