Herpes esophagitis

Herpes esophagitis is one of the infectious esophagitis that usually affects immunocompromised patients.

Epidemiology 

It occurs as an opportunistic infection in immunocompromised patients, particularly those with AIDS. It has also been described in immunocompetent individuals .

Pathology

The etiological agent is the herpes simplex virus (HSV), which is a double-stranded DNA virus classified into two subtypes: HSV-1 and HSV-2.

It can be a consequence of viremia, reactivation of HSV, or even a direct spread of the virus to esophageal mucosa from the vagus nerve in immunocompromised patients. The definitive diagnosis is made with endoscopic biopsy .

Radiographic features

Fluoroscopy

On double contrast studies, it manifests as multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo.

Treatment and prognosis

It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment .

Complications

• esophageal perforation
• mediastinitis
• gastrointestinal bleeding

Differential diagnosis

Other causes of infectious esophagitis:

• candida esophagitis
• cytomegalovirus esophagitis
• HIV esophagitis