
==== Front
Gastro Hep Adv
Gastro Hep Adv
Gastro Hep Advances
2772-5723
Elsevier

S2772-5723(24)00085-2
10.1016/j.gastha.2024.06.005
Images of the Month
Herpes Simplex Esophagitis: Coinfection in an Immunocompetent Host
Deen Samier sdeen@honorhealth.com
1∗
Levinthal Gavin 2
Asbury Kara 3
1 Department of Internal Medicine, HonorHealth/Thompson Peak Medical Center, Scottsdale, Arizona
2 Department of Gastroenterology, HonorHealth/Thompson Peak Medical Center, Scottsdale, Arizona
3 Apex Infectious Diseases, HonorHealth/Thompson Peak Medical Center, Scottsdale, Arizona
∗ Correspondence: Address correspondence to: Samier Deen, DO, Department of Internal Medicine, HonorHealth/Thompson Peak Medical Center, 7400 E. Thompson Peak Pkwy, Scottsdale, Arizona 85255, USA. sdeen@honorhealth.com
21 6 2024
2024
21 6 2024
3 7 942943
18 5 2024
5 6 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcAn 18-year-old male presented to the emergency department with a 1-week history of fevers, intractable vomiting, and epigastric pain in the setting of recent unprotected sex with 1 female partner. Physical examination was notable for mild epigastric tenderness. During the hospitalization, the patient complained of a sore throat, odynophagia, and retrosternal pain. Gastroenterology evaluated the patient and performed an esophagogastroduodenoscopy, which revealed severe ulcerative esophagitis involving the mid to distal esophagus (Figure A and B). Histology was consistent with herpetic esophagitis, with qualitative immunostains demonstrating features of both herpes simplex virus (HSV)-1 (Figure C) and focal HSV-2 (Figure D) by virtue of positively stained brown nuclei. Fourth-generation HIV antigen/antibody screen and HSV immunoglobulin G serology testing results were negative. The patient was initiated on intravenous acyclovir 5 mg/kg every 8 hours and then transitioned to oral acyclovir 400 mg 3 times per day, to complete a 10-day course. The patient was discharged home on oral proton pump inhibitor therapy and advised to follow up closely with gastroenterology for a repeat esophagogastroduodenoscopy in three months. At a follow-up visit 1 week after initiating antiviral therapy, the patient achieved complete resolution of symptoms and was tolerating a regular diet without difficulty.

Conflicts of Interest: The authors disclose no conflicts.

Funding: The authors report no funding.

Ethical Statement: Institutional review board approval was not required as no systematic investigation was performed.

Reporting Guidelines: None.
