Atypical manifestation of herpes esophagitis in an immunocompetent patient: Case report and literature review

摘要

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.