Herpes esophagitis

Endoscopic image of Herpes esophagitis
Specialty| Infectious disease, gastroenterology

Herpes esophagitis is a viral infection of the esophagus caused by Herpes simplex virus (HSV).

While the disease most often occurs in immunocompromised patients, including post-chemotherapy, immunosuppression with organ transplants[1] and in AIDS,[2] herpes esophagitis can also occur in immunocompetent individuals.[3]

## Contents

* 1 Signs and symptoms
* 2 Diagnosis
* 2.1 Differential diagnosis
* 3 Prevention
* 4 Treatment
* 5 References

## Signs and symptoms[edit | edit source]

People with herpes esophagitis experience pain with eating and trouble swallowing. Other symptoms can include food impaction,[4] hiccups,[5] weight loss, fever,[3] and on rare occasions upper gastrointestinal bleeding as noted in the image above[6] and tracheoesophageal fistula.[7] Frequently one can see herpetiform lesions in the mouth and lips.

## Diagnosis[edit | edit source]

* Acute herpetic esophagitis-Endoscopy revealed multiple, well-circumscribed vesicular eruptions scattered along the entire esophagus

* Micrograph of an esophageal biopsy showing herpes eosphagitis, with the characteristic nuclear changes (nuclear moulding, chromatin clumping at the nuclear membrane (margination) and multinucleation). H&E stain.

Upper Endoscopy often reveals ulcers throughout the esophagus with intervening normal-appearing mucosa. In severe cases the ulcers can coalesce and on rare occasions have a black appearance known as black esophagus.[8] While the diagnosis of herpes esophagitis can be inferred clinically it can only be accurately diagnosed through endoscopically obtained biopsies with microscopic evaluation by a pathologist finding the appropriate inclusion bodies and diagnostic immunochemical staining.[9] False negative findings may occur if biopsies are taken from the ulcer rather than from the margin of the ulcer as the inclusion particles are to be found in viable epithelial cells. Viral tissue culture represents the most accurate means of diagnosing the precise cause.

### Differential diagnosis[edit | edit source]

CMV, VZV as well as HIV infections of the esophagus can have a similar presentation. Tissue culture is the most accurate means of distinguishing between the different viral causes.[10] Caustic esophagitis, pill-induced esophagitis as well as yeast esophagitis can have a similar clinical presentation.

## Prevention[edit | edit source]

Herpes simplex virus is commonly found in humans, yet uncommonly results in systemic manifestations. 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.

## Treatment[edit | edit source]

Antivirals such as acyclovir, famciclovir, or valacyclovir may be used. Intravenous acyclovir is reserved for individuals who cannot swallow due to the pain, individuals with other systemic manifestations of herpes or severely immunocompromised individuals.

## References[edit | edit source]

1. ↑ Miller GG, Dummer JS (April 2007). "Herpes simplex and varicella zoster viruses: forgotten but not gone". Am. J. Transplant. 7 (4): 741–7. doi:10.1111/j.1600-6143.2006.01718.x. PMID 17391119.
2. ↑ McBane RD, Gross JB (1991). "Herpes esophagitis: clinical syndrome, endoscopic appearance, and diagnosis in 23 patients". Gastrointest. Endosc. 37 (6): 600–3. doi:10.1016/s0016-5107(91)70862-6. PMID 1756917.
3. ↑ 3.0 3.1 Kato S, Yamamoto R, Yoshimitsu S, et al. (2005). "Herpes simplex esophagitis in the immunocompetent host". Diseases of the Esophagus. 18 (5): 340–4. doi:10.1111/j.1442-2050.2005.00510.x. PMID 16197537.
4. ↑ Marshall JB, Smart JR, Elmer C, Lillich MA, Diaz-Arias AA (September 1992). "Herpes esophagitis causing an unsuspected esophageal food bolus impaction in an institutionalized patient". J. Clin. Gastroenterol. 15 (2): 179–80. doi:10.1097/00004836-199209000-00032. PMID 1328357.
5. ↑ Mulhall BP, Nelson B, Rogers L, Wong RK (May 2003). "Herpetic esophagitis and intractable hiccups (singultus) in an immunocompetent patient". Gastrointest. Endosc. 57 (6): 796–7. doi:10.1067/mge.2003.212. PMID 12739568.
6. ↑ Takeno M, Adachi H, Nakahama T, Inagaki Y, Morimoto H, Watanabe K (August 2002). "[Herpes esophagitis presenting upper gastrointestinal bleeding: report of a case]". Nihon Shokakibyo Gakkai Zasshi (in 日本語). 99 (8): 935–40. PMID 12229166.
7. ↑ Obrecht WF, Richter JE, Olympio GA, Gelfand DW (November 1984). "Tracheoesophageal fistula: a serious complication of infectious esophagitis". Gastroenterology. 87 (5): 1174–9. doi:10.1016/S0016-5085(84)80082-7. PMID 6592123.
8. ↑ Nagri S, Hwang R, Anand S, Kurz J (February 2007). "Herpes simplex esophagitis presenting as acute necrotizing esophagitis ("black esophagus") in an immunocompetent patient". Endoscopy. 39 (Suppl 1): E169. doi:10.1055/s-2007-966619. PMID 17614059.
9. ↑ Bennett WE, Tarr PI (January 2009). "Enteric infections and diagnostic testing". Curr. Opin. Gastroenterol. 25 (1): 1–7. doi:10.1097/MOG.0b013e32831ba094. PMID 19114768. S2CID 20430314.
10. ↑ Meinhard Classen; Guido N. J. Tytgat; M.D. Ph.D.; Charles J. Lightdale (2010). Gastroenterological Endoscopy. Thieme. pp. 490–. ISBN 978-3-13-125852-6. Archived from the original on 9 May 2013. Retrieved 26 June 2010.

Classification|

* ICD-10: B00.9
* ICD-9-CM: 054.79

|

* v
* t
* e

Diseases of the digestive system

Upper GI tract|

| Esophagus|

* Esophagitis
* Candidal
* Eosinophilic
* Herpetiform
* Rupture
* Boerhaave syndrome
* Mallory–Weiss syndrome
* UES
* Zenker's diverticulum
* LES
* Barrett's esophagus
* Esophageal motility disorder
* Nutcracker esophagus
* Achalasia
* Esophagogastric junction outflow obstruction
* Diffuse esophageal spasm
* Gastroesophageal reflux disease (GERD)
* Laryngopharyngeal reflux (LPR)
* Esophageal stricture
* Megaesophagus
* Esophageal intramural pseudodiverticulosis
* Acute esophageal necrosis

|

Stomach|

* Gastritis
* Atrophic
* Ménétrier's disease
* Gastroenteritis
* Peptic (gastric) ulcer
* Cushing ulcer
* Dieulafoy's lesion
* Dyspepsia
* Pyloric stenosis
* Achlorhydria
* Gastroparesis
* Gastroptosis
* Portal hypertensive gastropathy
* Gastric antral vascular ectasia
* Gastric dumping syndrome
* Gastric volvulus
* Buried bumper syndrome
* Gastrinoma
* Zollinger–Ellison syndrome

Lower GI tract
Enteropathy|

| Small intestine
(Duodenum/Jejunum/Ileum)|

* Enteritis
* Duodenitis
* Jejunitis
* Ileitis
* Peptic (duodenal) ulcer
* Curling's ulcer
* Malabsorption: Coeliac
* Tropical sprue
* Blind loop syndrome
* Small intestinal bacterial overgrowth
* Whipple's
* Short bowel syndrome
* Steatorrhea
* Milroy disease
* Bile acid malabsorption

|

Large intestine
(Appendix/Colon)|

* Appendicitis
* Colitis
* Pseudomembranous
* Ulcerative
* Ischemic
* Microscopic
* Collagenous
* Lymphocytic
* Functional colonic disease
* IBS
* Intestinal pseudoobstruction / Ogilvie syndrome
* Megacolon / Toxic megacolon
* Diverticulitis/Diverticulosis/SCAD

Large and/or small|

* Enterocolitis
* Necrotizing
* Gastroenterocolitis
* IBD
* Crohn's disease
* Vascular: Abdominal angina
* Mesenteric ischemia
* Angiodysplasia
* Bowel obstruction: Ileus
* Intussusception
* Volvulus
* Fecal impaction
* Constipation
* Diarrhea
* Infectious
* Intestinal adhesions

Rectum|

* Proctitis
* Radiation proctitis
* Proctalgia fugax
* Rectal prolapse
* Anismus

Anal canal|

* Anal fissure/Anal fistula
* Anal abscess
* Hemorrhoid
* Anal dysplasia
* Pruritus ani

GI bleeding|

* Blood in stool
* Upper
* Hematemesis
* Melena
* Lower
* Hematochezia

Accessory|

| Liver|

* Hepatitis
* Viral hepatitis
* Autoimmune hepatitis
* Alcoholic hepatitis
* Cirrhosis
* PBC
* Fatty liver
* NASH
* Vascular
* Budd–Chiari syndrome
* Hepatic veno-occlusive disease
* Portal hypertension
* Nutmeg liver
* Alcoholic liver disease
* Liver failure
* Hepatic encephalopathy
* Acute liver failure
* Liver abscess
* Pyogenic
* Amoebic
* Hepatorenal syndrome
* Peliosis hepatis
* Metabolic disorders
* Wilson's disease
* Hemochromatosis

|

Gallbladder|

* Cholecystitis
* Gallstone / Cholelithiasis
* Cholesterolosis
* Adenomyomatosis
* Postcholecystectomy syndrome
* Porcelain gallbladder

Bile duct/
Other biliary tree|

* Cholangitis
* Primary sclerosing cholangitis
* Secondary sclerosing cholangitis
* Ascending
* Cholestasis/Mirizzi's syndrome
* Biliary fistula
* Haemobilia

* Common bile duct
* Choledocholithiasis
* Biliary dyskinesia
* Sphincter of Oddi dysfunction

Pancreatic|

* Pancreatitis
* Acute
* Chronic
* Hereditary
* Pancreatic abscess
* Pancreatic pseudocyst
* Exocrine pancreatic insufficiency
* Pancreatic fistula

Other|

| Hernia|

* Diaphragmatic
* Congenital
* Hiatus

* Inguinal
* Indirect
* Direct
* Umbilical
* Femoral
* Obturator
* Spigelian

* Lumbar
* Petit's
* Grynfeltt-Lesshaft

* Undefined location
* Incisional
* Internal hernia
* Richter's

|

Peritoneal|

* Peritonitis
* Spontaneous bacterial peritonitis
* Hemoperitoneum
* Pneumoperitoneum

* v
* t
* e

Skin infections, symptoms and signs related to viruses

| DNA virus|

| Herpesviridae|

| Alpha.|

| HSV|

* Herpes simplex
* Herpetic whitlow
* Herpes gladiatorum
* Herpes simplex keratitis
* Herpetic sycosis
* Neonatal herpes simplex
* Herpes genitalis
* Herpes labialis
* Eczema herpeticum
* Herpetiform esophagitis

|

B virus|

* B virus infection

VZV|

* Chickenpox
* Herpes zoster
* Herpes zoster oticus
* Ophthalmic zoster
* Disseminated herpes zoster
* Zoster-associated pain
* Modified varicella-like syndrome

Beta.|

* Human herpesvirus 6/Roseolovirus
* Exanthema subitum
* Roseola vaccinia
* Cytomegalic inclusion disease

Gamma.|

* KSHV
* Kaposi's sarcoma

Poxviridae|

| Ortho.|

* Variola
* Smallpox
* Alastrim
* MoxV
* Monkeypox
* CPXV
* Cowpox
* VV
* Vaccinia
* Generalized vaccinia
* Eczema vaccinatum
* Progressive vaccinia
* Buffalopox

|

Para.|

* Farmyard pox: Milker's nodule
* Bovine papular stomatitis
* Pseudocowpox
* Orf
* Sealpox

Other|

* Yatapoxvirus: Tanapox
* Yaba monkey tumor virus
* MCV
* Molluscum contagiosum

Papillomaviridae|

| HPV|

* Wart/plantar wart
* Heck's disease
* Genital wart
* giant
* Laryngeal papillomatosis
* Butcher's wart
* Bowenoid papulosis
* Epidermodysplasia verruciformis
* Verruca plana
* Pigmented wart
* Verrucae palmares et plantares

|

* BPV
* Equine sarcoid

Parvoviridae|

* Parvovirus B19
* Erythema infectiosum
* Reticulocytopenia
* Papular purpuric gloves and socks syndrome

Polyomaviridae|

* Merkel cell polyomavirus
* Merkel cell carcinoma

RNA virus|

| Paramyxoviridae|

* MeV
* Measles

|

Togaviridae|

* Rubella virus
* Rubella
* Congenital rubella syndrome ("German measles")
* Alphavirus infection
* Chikungunya fever

Picornaviridae|

* CAV
* Hand, foot, and mouth disease
* Herpangina
* FMDV
* Foot-and-mouth disease
* Boston exanthem disease

Ungrouped|

* Asymmetric periflexural exanthem of childhood
* Post-vaccination follicular eruption
* Lipschütz ulcer
* Eruptive pseudoangiomatosis
* Viral-associated trichodysplasia
* Gianotti–Crosti syndrome

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