[Herpes simplex esophagitis in immunocompetent individuals.].

OBJECTIVE

Infections by herpes simplex viruses (HSV) are common but esophageal involvement is relatively rare. It is most frequently diagnosed in immunocompromized patients. We describe four healthy, young men with HSV esophagitis and review the literature on the subject.

METHODS

The diagnosis of HSV esophagitis was considered likely if three out of four of our criteria were met but definite if all four were fulfilled. IgM and IgG against HSV was measured with two different ELISAs. Viral culture was done in Vero and A-549 cells. Virus typing was done with ELISA. Histopathological exam was performed. A MEDLINE search of HSV esophagitis among otherwise healthy individuals was performed and the literature reviewed.

RESULTS

Four young, healthy men were diagnosed with HSV esophagitis in 1997. Diagnosis was likely in two cases and definite in two. One patient was initially suspected of heart disease and another of gallbladder disease. All four patients were proven to have primary infection, were hospitalized, given intravenous hydration and treated with acyclovir. A MEDLINE search revealed 12 other cases of HSV esopha notgitis in otherwise healthy individuals. Including all 16 cases, the age ranged from 18 to 50 years (mean age 26 years). There were two women and 14 men. The most frequent symptom was odynophagia (69%). Eight patients (50%) had fever but only six (37.5%)had lesions in skin and/or mucosa on examination. Esophageal ulcers or inflammation were detected in all patients. The changes were in the distal esophagus (13/16), in the middle (2/16) or the entire organ (1/16). HSV-1 was cultured from 10 patients. Viral inclusions were seen in esophageal samples from eight patients. HSV antibodies were measured in 10 patients, six of which were proven to have primary infection.

CONCLUSIONS

HSV esophagitis is rare in otherwise healthy individuals but probably underdiagnosed. Most cases are young men. Clues to the diagnosis such as visible lesions in skin or mucosae are frequently not present. Vigilance and endoscopy with biopsies and culture is needed for an accurate diagnosis.