Herpes esophagitis

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Herpes oesophagitis is one of the infectious oesophagitis 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 ³.

Pathology

The aetiological 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 viraemia, reactivation of HSV, or even a direct spread of the virus to oesophageal mucosa from the vagus nerve in immunocompromised patients. The definitive diagnosis is made with endoscopic biopsy ¹.

Radiographic features

Fluoroscopy

On double contrast studies, it manifests as multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo. It has a predilection for the middle third of the oesophagus ⁴.

Treatment and prognosis

It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment ¹.

Complications

Differential diagnosis

Other causes of infectious oesophagitis:

-<p><strong>Herpes oesophagitis </strong>is one of the <a href="/articles/infectious-oesophagitis">infectious oesophagitis</a> that usually affects immunocompromised patients. </p><h4>Epidemiology </h4><p>It occurs as an opportunistic infection in immunocompromised patients, particularly those with <a href="/articles/hivaids">AIDS</a>. It has also been described in immunocompetent individuals <sup>3</sup>.</p><h4>Pathology</h4><p>The aetiological agent is the herpes simplex virus (HSV), which is a double-stranded DNA virus classified into two subtypes: HSV-1 and HSV-2.</p><p>It can be a consequence of viraemia, reactivation of HSV, or even a direct spread of the virus to oesophageal mucosa from the vagus nerve in immunocompromised patients. The definitive diagnosis is made with endoscopic biopsy <sup>1</sup>. </p><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p>On double contrast studies, it manifests as multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo.</p><h4>Treatment and prognosis</h4><p>It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment <sup>1</sup>.</p><h5>Complications</h5><ul>
~~-<li>oesophageal perforation <sup>1,2</sup>~~
~~-</li>~~
~~-<li>mediastinitis</li>~~
~~-<li>gastrointestinal bleeding</li>~~
~~-</ul><h4>Differential diagnosis</h4><p>Other causes of <a href="/articles/infectious-oesophagitis">infectious oesophagitis</a>:</p><ul>~~
~~-<li><a href="/articles/candida-oesophagitis">candida oesophagitis</a></li>~~
~~-<li><a href="/articles/cytomegalovirus-oesophagitis">cytomegalovirus oesophagitis</a></li>~~
~~-<li><a href="/articles/hiv-oesophagitis">HIV oesophagitis </a></li>~~
+<p><strong>Herpes oesophagitis </strong>is one of the infectious <a href="/articles/oesophagitis" title="Oesophagitis">oesophagitis</a> that usually affects immunocompromised patients. </p><h4>Epidemiology </h4><p>It occurs as an opportunistic infection in immunocompromised patients, particularly those with <a href="/articles/hivaids">AIDS</a>. It has also been described in immunocompetent individuals <sup>3</sup>.</p><h4>Pathology</h4><p>The aetiological agent is the herpes simplex virus (HSV), which is a double-stranded DNA virus classified into two subtypes: HSV-1 and HSV-2.</p><p>It can be a consequence of viraemia, reactivation of HSV, or even a direct spread of the virus to oesophageal mucosa from the vagus nerve in immunocompromised patients. The definitive diagnosis is made with endoscopic biopsy <sup>1</sup>. </p><h4>Radiographic features</h4><h5>Fluoroscopy</h5><p>On double contrast studies, it manifests as multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo. It has a predilection for the middle third of the oesophagus <sup>4</sup>.</p><h4>Treatment and prognosis</h4><p>It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment <sup>1</sup>.</p><h5>Complications</h5><ul>
+<li><p><a href="/articles/oesophageal-perforation" title="Oesophageal perforation">oesophageal perforation</a> <sup>1,2</sup></p></li>
+<li><p><a href="/articles/mediastinitis" title="Mediastinitis">mediastinitis</a></p></li>
+<li><p><a href="/articles/upper-gastrointestinal-bleeding" title="Upper gastrointestinal bleeding">gastrointestinal bleeding</a></p></li>
+</ul><h4>Differential diagnosis</h4><p>Other causes of infectious oesophagitis:</p><ul>
+<li><p><a href="/articles/candida-oesophagitis">candida oesophagitis</a></p></li>
+<li><p><a href="/articles/cytomegalovirus-oesophagitis" title="cytomegalovirus oesophagitis">cytomegalovirus oesophagitis</a></p></li>
+<li><p><a href="/articles/hiv-oesophagitis">HIV oesophagitis</a></p></li>

References changed:

1. Eymard D, Martin L, Doummar G, Piché J. Herpes Simplex Esophagitis in Immunocompetent Hosts. Can J Infect Dis. 1997;8(6):351-3. <a href="https://doi.org/10.1155/1997/397147">doi:10.1155/1997/397147</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22346532">Pubmed</a>
2. Cronstedt J, Bouchama A, Hainau B, Halim M, Khouqeer F, al Darsouny T. Spontaneous Esophageal Perforation in Herpes Simplex Esophagitis. Am J Gastroenterol. 1992;87(1):124-7. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/1728108">Pubmed</a>
3. Levine M & Rubesin S. Diseases of the Esophagus: Diagnosis with Esophagography. Radiology. 2005;237(2):414-27. <a href="https://doi.org/10.1148/radiol.2372050199">doi:10.1148/radiol.2372050199</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/16170017">Pubmed</a>
4. Wolfgang Dähnert. Radiology Review Manual. (2011) ISBN: 9781451118124 - <a href="http://books.google.com/books?vid=ISBN9781451118124">Google Books</a>
1. Eymard D, Martin L, Doummar G et-al. Herpes simplex esophagitis in immunocompetent hosts. Can J Infect Dis. 2012;8 (6): 351-3. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250898">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/22346532">Pubmed citation</a><span class="auto"></span>
2. Cronstedt JL, Bouchama A, Hainau B et-al. Spontaneous esophageal perforation in herpes simplex esophagitis. Am. J. Gastroenterol. 1992;87 (1): 124-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1728108">Pubmed citation</a><span class="auto"></span>
3. Levine MS, Rubesin SE. Diseases of the esophagus: diagnosis with esophagography. Radiology. 2005;237 (2): 414-27. <a href="http://radiology.rsna.org/content/237/2/414.full">Radiology (full text)</a> - <a href="http://dx.doi.org/10.1148/radiol.2372050199">doi:10.1148/radiol.2372050199</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/16170017">Pubmed citation</a><span class="ref_v3"></span>