Glossitis and esophagitis from herpes simplex virus type 1 infection

摘要

An 81-year-old woman presented to the emergency department with a 2-week history of malaise, fever and anorexia, with oral pain and odynophagia. Her medical history was remarkable only for type 2 diabetes mellitus. She was not taking any immunosuppressive agents. Her body temperature was 37.7°C, and other vital signs were normal. Physical examination showed multiple yellowish-white, pseudomembranous lesions on the patient’s tongue (Figure 1A). The rest of the physical examination was unremarkable. Esophagogastroduodenoscopy showed multiple shallow ulcers with a white coating (Figure 1B and Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/ cmaj.210352/tab-related-content). Glossal and esophageal biopsies showed multinucleated cells with moulded, groundglass nuclei (Appendix 2, available at www.cmaj.ca/lookup/doi/10.1503/cmaj ,210352/tab-related-content). Results from polymerase chain reaction and immunohistochemical staining of the specimens were positive for herpes simplex virus type 1 (HSV-1), and we diagnosed herpetic glossitis and esophagitis. We did not find any evidence of malignant disease on a whole body computed tomography scan and upper and lower endoscopy. The patient’s HIV test result was negative and her hemoglobin A1c was 7.2%. We treated her with a 7-day course of acyclovir, intravenously because of her odynophagia, and the oral and esophageal lesions completely resolved.