acyclovir and Esophagitis

Herpes esophagitis (HE) is common in immunosuppressed patients, but has rarely been reported in immunocompetent individuals, in whom it appears to be a self-limited illness. We describe 3 new cases of HE in otherwise healthy patients seen in our hospital within the last 5 years. We performed a comprehensive review of the previously reported cases of HE in immunocompetent adults and adolescents in the English and Spanish literature. We analyzed the clinical features, treatment, and outcome of this entity. A total of 56 patients were included (39 men and 17 women), with a mean age of 35 years. The most common clinical manifestations were odynophagia (60.7%), fever (51.8%), and retrosternal chest pain (46.4%). A prodrome of upper respiratory symptoms and concurrent orolabial herpetic lesions were present in 26.8% and 25% of cases, respectively. Gastrointestinal bleeding was a rare complication (5.3%). Endoscopy revealed multiple ulcers in most cases (58.9%), typically involving the distal or mid-esophagus (83%). The diagnosis was confirmed by histopathologic examination in 40 cases (71.4%), by tissue viral culture in 21 (37.5%), and by detection of viral genome in esophageal samples in 4 cases (7.1%). Herpes simplex virus type 1 (HSV-1) was identified in 27 cases and herpes simplex virus type 2 (HSV-2) only in 1 case. Serology was consistent with a primary infection in 11 of the 25 evaluable cases (44%). Acyclovir therapy was used in 45.4% of patients. The outcome was favorable in all cases, although an esophageal perforation occurred in 1 patient. HE is a rare but well-defined entity in healthy adults and adolescents, and is probably underdiagnosed. A high degree of suspicion and a prompt endoscopic examination are required for the diagnosis. It is usually a self-limited infection, but early treatment with acyclovir may hasten the resolution of symptoms. Nevertheless, the benefit of antiviral therapy remains unknown.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Esophagitis; Female; Herpes Simplex; Humans; Immunocompromised Host; Male; Middle Aged

Concomitant herpetic and candidal esophagitis is a very rare disease that had not been reported in uremic patients. A 57-year-old woman receiving continuous ambulatory peritoneal dialysis (CAPD) therapy for 3 years was admitted due to CAPD-related peritonitis. Endoscopic examination was performed due to severe epigastralgia and upper gastrointestinal bleeding, and combined herpetic and candidal esophagitis was diagnosed. Intravenous acyclovir and fluconazole were prescribed and symptoms improved. The patient subsequently died due to progressive sepsis and respiratory failure. This is the first report of a dual infectious esophagitis in a uremic patient. Since infectious esophagitis may cause severe complications, early diagnosis and aggressive treatment are important.

Topics: Acyclovir; Antifungal Agents; Antiviral Agents; Candidiasis; Esophagitis; Fatal Outcome; Female; Fluconazole; Herpes Simplex; Humans; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Sepsis; Uremia

The aim of this study was to delineate the characteristics of herpes simplex virus esophagitis (HSVE) in the immunocompetent host.. The study entailed a case report and a review of relevant literature through a MEDLINE search back to 1966. All cases with documented HSVE in patients without immunosuppression were selected and their characteristics defined.. A total of 38 cases were identified. The age range was 1-76 yr and the male/female ratio 3.2/1. Antecedent exposure to HSV disease was described in eight cases (21.1%). A prodrome of systemic manifestations preceded the onset of esophageal symptoms in nine subjects (23.6%). Manifestations included acute odynophagia (76.3%), heartburn (50%), and fever (44.7%). Concurrent oropharyngeal lesions were uncommon (n = 8, 21.1%). Endoscopically, extensive involvement was common, showing friable mucosa (84.2%), numerous ulcers (86.8%), and whitish-exudates (39.5%). The distal esophagus was most commonly affected (63.8%). Microscopic examination showed characteristic viral cytopathology in 26 (68.4%) cases. Virus was recovered from esophageal-brushes or biopsies in 23 of 24 (95.8%) patients and immunocytochemistry was positive in seven of eight (87.5%) cases. Immune status was consistent with primary HSV infection in eight (21.1%) cases. The disease was self-limiting, although esophageal perforation and upper GI bleeding were reported in one case each.. HSVE in the immunocompetent host is a rare but distinct entity, and is significantly more common in male subjects. It represents either primary infection or reactivation, and is characterized by acute onset, systemic manifestations, and extensive erosive-ulcerative involvement of the mid-distal esophagus. Histopathological examination alone may miss the diagnosis; adding tissue-viral culture optimizes the diagnostic sensitivity. It is usually self-limiting; whether antiviral therapy is beneficial remains unknown.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Biopsy; CD4-CD8 Ratio; Diagnosis, Differential; Esophagitis; Esophagoscopy; Esophagus; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Retrospective Studies

A 35-yr-old, immunocompetent male was admitted complaining of severe odynophagia. He was diagnosed as having herpes simplex esophagitis and was started on intravenous acyclovir 5 mg/kg every 8 h on the day of admission. His response was dramatic. Within 24 h he was virtually asymptomatic. Acyclovir therapy in immunocompetent adults with esophagitis has been described in only a handful of cases in the literature, although the therapy is well established in immunocompromised patients. We review the English literature and discuss the efficacy of the therapy. Acyclovir therapy may be beneficial in immunocompetent patients with particularly severe odynophagia.

Topics: Acyclovir; Adult; Esophagitis; Herpes Simplex; Humans; Immunocompetence; Injections, Intravenous; Male

Topics: Acyclovir; Burns, Chemical; Diagnosis, Differential; Esophageal Stenosis; Esophagitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Infant; Lye

Topics: Acyclovir; Autonomic Nervous System Diseases; Encephalitis; Esophagitis; Facial Dermatoses; Female; Fingers; Hepatitis, Viral, Human; Herpes Genitalis; Herpes Labialis; Herpes Simplex; Humans; Infant, Newborn; Keratitis, Dendritic; Male; Peripheral Nervous System Diseases; Recurrence; Respiratory Tract Infections; Stomatitis, Herpetic; Vaccination; Viral Vaccines

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Diagnosis, Differential; Esophagitis; Female; Glossitis; Herpes Simplex; Herpesvirus 1, Human; Humans

A 77-year-old woman presented with a 2-week history of malaise, prostration, anorexia, abdominal pain, vomiting and diarrhoea. She had been taking systemic corticosteroids for the past year. During hospitalisation, renal insufficiency, ionic changes and liver function abnormalities were detected and corrected. However, the patient developed total dysphagia. UGE revealed multiple shallow ulcers below the cricopharyngeal level and in the distal oesophagus, with normal-appearing intervening mucosa. Histological examination allowed the diagnosis of herpes simplex virus esophagitis. Treatment with intravenous acyclovir was instituted for 14 days. In the elderly, herpetic esophagitis may present with non-specific complains, such as prostration or anorexia. In the reported case, dysphagia was only detected as a late symptom, addressing the importance of maintaining a high degree of suspicion for the diagnosis of herpes simplex virus esophagitis.

Topics: Acyclovir; Aged; Esophageal Diseases; Esophagitis; Female; Herpes Simplex; Humans; Simplexvirus

Herpes simplex virus-1 (HSV-1) oesophagitis as an aetiology of persistent hiccough is a rarity in immunocompetent hosts and entails an exhaustive diagnostic work-up, since it does not present with any of the typical oesophagitis symptoms. Our patient presented with persistent hiccoughs that were resistant to treatment with baclofen. Oesophagogastroduodenoscopy with biopsy confirmed the diagnosis of HSV-1 oesophagitis. The hiccough subsided within 48 h of aciclovir therapy.

Topics: Acyclovir; Antiviral Agents; Esophagitis; Herpesvirus 1, Human; Hiccup; Humans

Genetic aberrations in the toll-like receptor (TLR)3 pathway are associated with increased susceptibility to herpes simplex virus (HSV) infections. Leucine-rich repeat and PYD-containing protein (NLRP)12 is a component of the inflammasome apparatus, which is critical to an immediate innate inflammatory response. Aberrations in NLRP12 have been shown to mediate auto-inflammation. In this study, we present a 44-year old patient with severe HSV esophagitis and Crohn's disease. An immune and genetic investigation confirmed two coinciding genetic mutations in TLR3 and NLRP12. Our findings support conducting laboratory workup that targets TLR3 pathway in the immunocompetent host developing recurrent HSV infections.

Topics: Acyclovir; Adult; Antibodies, Monoclonal, Humanized; Antiviral Agents; Crohn Disease; Esophagitis; Female; Gastrointestinal Agents; Herpes Simplex; Humans; Intracellular Signaling Peptides and Proteins; Mutation; Signal Transduction; Toll-Like Receptor 3; Valganciclovir; Whole Genome Sequencing

Herpetic esophagitis (EH) usually affects those who are immunocompromised and is uncommon in immunocompetent patients. In these cases, EH may occasionally present as an acute and self-limited illness. Such cases are rare and only a few have beenreported and limited published reviews exist making the benefits of antiviral therapy in immunocompetent patients unknown.. We report four cases of young patients who presented dysphagia, odynophagia and epigastric pain. Endoscopic findings revealed lesions in the distal esophagus and histopathological changes compatible with herpes virus infection confirmed by viral DNA in every case. After treatment, every patient showed significant improvement and tolerated oral intake after discharge.. In this publication, we present four immunocompetent patients with EH, without relevant alterations in laboratory workup and with negative HIV status. This disease is infrequent in patients with such characteristics and there are few cases published. In order to better understand this pathology, we present the symptoms, the endoscopic alterations and the clinical evolution with treatment. In our series, 50% of patients had serology compatible with acute HVS type 1 infection, 25% had a subacute infection pattern (IgM and IgG positive antibodies) and in another 25% of patients, serology was not done. No patient presented leukocyte alterations, while all patients presented with anatomopathological findings compatible with acute herpetic esophagitis and responded to acyclovir therapy.

Topics: Acyclovir; Adolescent; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Esophagus; Female; Herpes Simplex; Humans; Immunocompromised Host; Male; Simplexvirus; Young Adult

Herpes simplex (HS) is an opportunistic infection, primarily in immunocompromised patients, caused by herpes simplex virus. Oral and genital mucosa are the most commonly involved sites; it is rare for HSV to invade the esophagus and cause esophagitis, especially in immunocompetent patients. Here, we present a case where an immunocompetent patient presented with HS esophagitis, which had evolved into esophageal ulcers. He was successfully treated with acyclovir. Subsequently, we did a comprehensive literature search and tabulated all the possible complications and management plans of previously reported cases of HS in immunocompetent patients.

Topics: Acyclovir; Antiviral Agents; Esophagitis; Herpes Simplex; Humans; Male

Topics: Acyclovir; Aged; Antiviral Agents; Esomeprazole; Esophagitis; Esophagus; Female; Gastroscopy; Herpes Simplex; Humans; Severity of Illness Index; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Biopsy; Candidiasis; Diagnosis, Differential; Esophagitis; Esophagoscopy; Herpes Simplex; Humans; Inclusion Bodies, Viral; Male

Herpes simplex virus (HSV) has various presentations, depending on the patient's immune status, age, and the route of transmission. In adults, HSV type 1 is found predominantly in the oral area, and HSV type 2 (HSV-2) is commonly found in the genital area. HSV-2 infection without genital lesions is uncommon. Herein we report a unique case of pharyngotonsillitis as an initial manifestation of disseminated HSV-2 infection without genital involvement.. A 46-year-old male was admitted to our hospital with a 1-week history of fever and sore throat. His past medical history included hypereosinophilic syndrome diagnosed at age 45 years. Physical examination revealed throat congestion, bilaterally enlarged tonsils with exudates, tender cervical lymphadenopathy in the left posterior triangle, and mild epigastric tenderness. The laboratory data demonstrated bicytopenia, elevated liver enzyme levels, and hyperferritinemia. A bone marrow smear showed hypocellular marrow with histiocytes and hemophagocytosis. The diagnosis of HLH was confirmed, and the patient was treated with methylprednisolone pulse therapy on days 1-3. On day 5, despite initial improvement of the fever and sore throat, multiple, new, small bullae developed on the patient's face, trunk, and extremities. Additional testing showed that he was positive for HSV-specific immunoglobulin M and immunoglobulin G. Disseminated HSV infection was suspected, and intravenous acyclovir (10 mg/kg every 8 h) was begun. A subsequent direct antigen test of a bulla sample was positive for HSV-2. Moreover, tonsillar and esophageal biopsies revealed viral inclusion bodies. Immunohistochemical staining and a quantitative real-time polymerase chain reaction (PCR) assay confirmed the presence of HSV-2. Disseminated HSV-2 infection with multiple bullae, tonsillitis, esophagitis, and suspected hepatic involvement was diagnosed. After a 2-week course of intravenous acyclovir, his hematological status and liver function normalized, and his cutaneous skin lesions resolved. He was discharged on day 22 in good general health and continued taking oral valacyclovir for viral suppression due to his immunosuppressed status.. Disseminated HSV-2 infection should be considered as one of the differential diagnoses in patients with pharyngotonsillitis and impaired liver function of unknown etiology even if there are no genital lesions.

Topics: Acyclovir; Esophagitis; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompromised Host; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pharyngitis; Tonsillitis; Urogenital System

Herpetic esophagitis (HE) is a common condition in immunosuppressed patients, but a rare entity in immunocompetent patients affecting especially male teenagers and young adults.. We report the case of a 5-year-old male patient, with a history of allergic rhinitis admitted in our clinic for acute onset fever refractory to antipyretics, chest pain, anorexia, refusal of solid food, accepting only small amounts of fluids, odynophagia, and epigastric pain. The clinical exam revealed severe malaise, pallor, decreased skin turgor, abdominal epigastric tenderness, heartburn at palpation within the epigastric area. The laboratory tests showed leukocytosis, monocytosis, hypoglycaemia, and elevated inflammatory biomarkers.. The serology tests for human immunodeficiency virus (HIV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) were negative, except for immunoglobulin G (IgG) anti-EBV which was positive. The chest radiography was normal, and the abdominal ultrasound showed abdominal bloating. The upper digestive endoscopy revealed friable esophageal mucosa, with multiple ulceration on the entire esophagus, and whitish exudates especially on the middle and lower part of the esophagus suggesting a possible eosinophilic esophagitis or caused by Candida. Despite the empirical initiated treatment, the patient's evolution was only slowly favorable. The histological exam established the diagnosis of HE.. We initiated acyclovir therapy with an outstandingly favorable evolution.. After 1 month, we detected the seroconversion of IgG anti-HSV. The patient's follow-up revealed no additional complaints.. Despite its rarity in immunocompetent individuals, HE must be taken into account even in otherwise healthy small children. Allergic conditions might represent a predisposing factor for HE.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Epstein-Barr Virus Infections; Esophagitis; Herpesvirus 4, Human; Humans; Immunoglobulin G; Male; Rhinitis, Allergic

Topics: Acyclovir; Aged; Antiviral Agents; Coinfection; Cytomegalovirus Infections; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Ganciclovir; Herpes Simplex; Humans; Hypoalbuminemia; Immunocompetence; Pain; Parenteral Nutrition; Ulcer

Topics: Abdominal Pain; Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Endoscopy, Gastrointestinal; Esophagitis; Esophagus; Herpes Simplex; Humans; Male; Simplexvirus

Topics: Acyclovir; Adult; Antiviral Agents; Esophagitis; Female; Herpes Simplex; Humans

Topics: Acyclovir; Aged; Antiviral Agents; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Ulcer; Valacyclovir; Valine

Topics: Acyclovir; Administration, Intravenous; Antacids; Antiviral Agents; Coronary Artery Bypass; Critical Illness; Endoscopy, Digestive System; Esophagitis; Esophagogastric Junction; Esophagus; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunohistochemistry; Middle Aged; Peptic Ulcer Hemorrhage; Postoperative Complications; Proton Pump Inhibitors; Treatment Outcome

We report a case of herpes esophagitis in a 35-year-old man with pemphigus vulgaris (PV) who was undergoing treatment with corticosteroids and mycophenolate mofetil (MMF). Pemphigus vulgaris is an autoimmune intraepithelial bullous disease resulting from pathogenic IgG antibodies toward desmoglein antigens that often requires long-term immunosuppressive therapy for control of disease symptoms. Herpes esophagitis is an ulcerative eruption caused by viral reactivation in the setting of immunosuppression. Acute odynophagia in patients undergoing systemic treatment of active PV has a broad differential and warrants prompt endoscopic evaluation.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Antiviral Agents; Esophagitis; Esophagoscopy; Herpes Simplex; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Pemphigus

The clinical observation of the patient at the age of 56 years, with lesions of the esophagus by the herpes simplex virus has been presented. The patient complained of odynophagia and dysphagia. Treatment with proton pump inhibitors in outpatient stage was not effective. On endoscopic examination revealed multiple ulcers in all parts of the esophagus. Herpes simplex virus has been detected in biopsy specimens of esophageal mucosa by the PCR method. Treatment with acyclovir led to rapid and complete clinical recovery. Analysis of the literature allowed making the conclusion about the importance and actuality this demonstration.

Topics: Acyclovir; Antiviral Agents; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Humans; Middle Aged; Simplexvirus; Treatment Outcome

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Esophagitis; Female; Frail Elderly; Herpes Simplex; Humans; Valacyclovir; Valine

Herpes simplex virus (HSV)-induced sepsis affects immunocompromised patients. We report here the case of an immunocompetent adult with sepsis, hepatitis, renal failure and esophagitis. The possibility of HSV should be considered in cases of sepsis without any evident cause, even in immunocompetent patients. The characteristic endoscopic and histological findings of the associated esophagitis may assist the etiology of sepsis.

Topics: Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Male; Middle Aged; Sepsis; Ulcer

A 34-year-old dental nurse presented with a 2-day history of retrosternal chest pain that was constant and 'burning' in nature. She was otherwise fit and well, no significant prior medical history and no ischaemic heart disease risk factors. Clinical examination was entirely normal apart from pyrexia of 38.3°C. Admission ECG showed ST depression in the inferior and anterolateral leads suggestive of myocardial ischaemia, consequently a CT coronary angiogram (CTCA) was performed. This showed normal coronary arteries, incidental distal oesophageal thickening was seen. Further history taking revealed that her youngest daughter had recently suffered from cold sores. The patient went on to have a diagnostic procedure, an oesophagogastroduodenoscopy. Biopsies confirmed acute oesophagitis with features suggestive of herpes virus infection. The patient responded promptly to oral acyclovir. This case highlights the value of CT coronary angiogram in identifying non-cardiac pathology in patients with a low pretest probability of coronary artery disease.

Topics: Acute Coronary Syndrome; Acyclovir; Adult; Antiviral Agents; Chest Pain; Coronary Angiography; Diagnosis, Differential; Esophagitis; Female; Herpesviridae Infections; Humans; Myocarditis; Pericarditis; Tomography, X-Ray Computed

Topics: Acyclovir; Afatinib; Aged; Antineoplastic Agents; Antiviral Agents; Carcinoma, Non-Small-Cell Lung; Cystitis; ErbB Receptors; Esophagitis; Hematuria; Herpes Simplex; Humans; Intestinal Perforation; Lung Neoplasms; Male; Molecular Targeted Therapy; Neoplasm Proteins; Peritonitis; Protein Kinase Inhibitors; Quinazolines; Valacyclovir; Valine; Viremia; Virus Activation

Herpes simplex virus (HSV) oesophagitis is well described in immunocompromised patients. In immunocompetent individuals HSV oesophagitis is rare. We present a case of HSV oesophagitis in a pregnant woman. A possible explanation for HSV oesophagitis during pregnancy is the decreased cellular immunity, leading to an increased frequency and severity of viral infections. Antiviral therapy is advocated in pregnancy.

Topics: Acyclovir; Adult; Antiviral Agents; Esophagitis; Female; Humans; Immunity, Cellular; Pregnancy; Pregnancy Complications, Infectious; Simplexvirus

Topics: Acute Disease; Acyclovir; Antiviral Agents; Endoscopy, Digestive System; Esophagitis; Female; Humans; Immunochemistry; Stomatitis, Herpetic; Young Adult

A 52-year-old woman with a 6-year history of systemic lupus erythematosus (SLE) developed acute abdominal pain, nausea, vomiting, and diarrhea accompanied by hypocomplementemia. Herpes simplex virus (HSV) esophagitis and lupus enteritis were diagnosed on the basis of the results of endoscopic and histological examinations and abdominal computed tomography (CT) findings. Treatment with acyclovir followed by high-dose intravenous steroids improved her symptoms. To our knowledge, this is the first case of simultaneous HSV esophagitis and lupus enteritis.

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Enteritis; Esophagitis; Female; Glucocorticoids; Herpes Simplex; Humans; Lupus Erythematosus, Systemic; Methylprednisolone; Middle Aged; Pulse Therapy, Drug; Simplexvirus; Treatment Outcome

Mediterranean spotted fever (MSF) is a tick-borne disease caused by Rickettsia conorii. Recently, complicated cases have been more frequently reported, even in previously healthy patients. We describe a case of severe MSF complicated by acute renal failure and associated with herpetic oesophagitis. Acyclovir therapy resulted in remission of oesophageal symptoms within 48 h.

Topics: Acute Kidney Injury; Acyclovir; Antibodies, Viral; Antiviral Agents; Boutonneuse Fever; Esophagitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Middle Aged; Rickettsia conorii; Treatment Outcome

Herpes simplex esophagitis (HSE) occurs mostly in immunocompromised patients and rarely in immunocompetent patients. We encountered an elderly patient, a biologically immunocompromised patient with HSE who had characteristic endoscopic features and responded to acyclovir therapy. An 82-year-old woman presented with high-grade fever and epigastric discomfort for several days. A diagnosis of bacterial pneumonia was made based on imaging studies and cultures. Despite antibiotic treatment, epigastric discomfort persisted. Endoscopy revealed multiple exudative and circumscribed shallow ulcers with slightly raised edges in the mid-distal esophagus. Esophageal biopsy specimens showed multinucleated giant cells with Cowdry type A intranuclear inclusion bodies in epithelial cells, which were positive for herpes simplex virus-type 1 DNA by polymerase chain reaction. Because a diagnosis of HSE was made, she was treated with acyclovir, resulting in esophageal mucosal healing. In elderly patients with esophageal symptoms, HSE should be considered.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Esophagitis; Female; Herpes Simplex; Humans; Immunocompromised Host

Topics: Acyclovir; Antiviral Agents; Carcinoma, Non-Small-Cell Lung; Endoscopy, Gastrointestinal; Esophagitis; Herpes Simplex; Herpes Zoster; Humans; Immunocompromised Host; Lung Neoplasms; Male; Middle Aged

Herpes simplex virus (HSV) infection usually occurs in immunocompromised or severely debilitated patients. It is not so common in patients with renal transplants. The diagnosis can only be made histologically. It usually occurs during or shortly after treatment of graft rejection with high-dose steroids. We have recently experienced a case of HSV esophagitis and nephropathy in the renal allograft biopsy, which was identified by histology, immunostaining, and electron microscopy. A 43-year-old woman underwent cadaveric renal transplantation with cyclosporine and prednisolone treatment. Twelve months later, she developed renal insufficiency and proteinuria. Allograft renal biopsy showed some evidence of acute rejection. She was treated with 3 successive days of methylprednisolone (1.0 g/d) intravenously and continued tapering of steroids. Three weeks after steroid pulse therapy, she had throat pain, oral cavity ulcer, dysphagia, and febrile sensation. Esophagoscopy revealed multiple confluent ulcers in the whole esophagus, and biopsy showed enlarged epithelial cells with prominent nuclei. Immunohistochemically, the epithelial cells were positive with a monoclonal antibody to HSV type 1. She was started on acyclovir intravenously, which was continued for a week. After a week, her symptoms began to improve and repeat endoscopy showed no residual esophagitis. A renal allograft infection with HSV can persist in heavily immunosuppressed patients with recurrent rejection episodes. HSV mainly affects tubular cells causing necrosis, a major reason for functional deterioration. A biopsy is required for diagnosis.

Topics: Acyclovir; Adult; Antiviral Agents; Cadaver; Esophagitis; Female; Graft Rejection; Herpes Simplex; Humans; Kidney Transplantation; Necrosis; Postoperative Complications; Tissue Donors

Topics: 2-Pyridinylmethylsulfinylbenzimidazoles; Acyclovir; Adolescent; Antifungal Agents; Antiviral Agents; Candidiasis; Esophagitis; Fluconazole; Herpes Simplex; Humans; Immunocompetence; Lansoprazole; Male; Omeprazole; Treatment Outcome

Topics: Acyclovir; Adolescent; Antiviral Agents; Esophagitis; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompetence; Male; Treatment Outcome

To review clinical, laboratory, endoscopic and histologic features, treatment and outcome of immunocompetent children with Herpes simplex virus esophagitis.. Retrospective analysis of the medical records of six children (five males) referred to our unit between 1997-2001.. The median age at presentation was 4 years. Fever was present in all, odynophagia/dysphagia in five, retrosternal pain in four, vomiting in three, drooling in two and irritability and drowsiness in one. The median time between the onset of symptoms and the diagnosis was 6.5 days. Endoscopy, performed in all, showed friable mucosa and erosive-ulcerative involvement, with histology showing inflammation and ulcerated esophagitis. Tissue viral culture was performed in five patients and was positive in three, and polymerase chain reaction was positive in two of four tested. Serology was consistent with primary Herpes simplex virus infection in all. All received nasogastric feeding and acyclovir. The outcome was very good.. This is an uncommon and under-recognized condition in the immunocompetent child. The most common symptoms are sometimes not diagnostic, particularly in very young children. The presence of unusual clinical signs may lead to a difficult and delayed diagnosis. Treatment with acyclovir may have hastened the resolution of symptoms, but a controlled clinical study was not performed.

Topics: Acyclovir; Antiviral Agents; Biopsy; Child; Child, Preschool; Esophagitis; Esophagoscopy; Female; Humans; Immunocompromised Host; Infant; Male; Retrospective Studies; Simplexvirus; Treatment Outcome

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Esophagitis; Esophagoscopy; Fever of Unknown Origin; Herpes Simplex; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Opportunistic Infections; Risk Factors

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Esophagitis; Hematemesis; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Omeprazole

Topics: Acyclovir; Antiviral Agents; Esophagitis; Esophagoscopy; Herpes Simplex; Humans; Male; Middle Aged

Herpetic esophagitis (HE) associated with human immunodeficiency virus (HIV) is a rare condition mainly reported as isolated cases. We thus decided to study this association and analyze the possible predisposing factors, clinical and endoscopic presentations, and clinical response to treatment. Thirty-four HIV-1-infected patients were identified: 27 had histologically or virologically confirmed HE and seven had probable HE, a retrospective diagnosis based on the efficacy of acyclovir given alone. The median CD4 cell count was 15/mm3. Recent predisposing factors (such as nasogastric procedures, steroid therapy, and anticancer therapy) were noted with regard to 16 of the 34 patients (47%). Odynophagia and/or chest pain occurred in 30 patients (88%). At the time of diagnosis of HE, extraesophageal herpes was found in only 13 patients (38%). Superficial ulcers of the distal third of the esophagus were present in 17 (50%). Among 20 of the 27 patients with confirmed HE that could be evaluated, therapy with acyclovir led to complete resolution in 16 and partial response in 3; 1 patient died of HE. Five patients (15%) suffered confirmed or possible relapses. The mean interval between the diagnosis of HE and death was 8.8 months. Herpes simplex virus may be responsible for ulcerated esophagitis that occurs in the advanced stages of AIDS and that can be safely treated with acyclovir before a definitive diagnosis is made.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Cortex Hormones; Adult; Aged; AIDS-Related Opportunistic Infections; Antineoplastic Agents; CD4 Lymphocyte Count; Esophagitis; Esophagoscopy; Female; Herpes Simplex; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Treatment Outcome

Herpetic esophageal primary infection is not a common event in immunocompetent patients. The case of a 27-year-old immunocompetent woman who developed herpetic esophagitis involving the whole esophagus as a manifestation of primary herpetic infection is presented. The endoscopic appearance initially suggested esophageal candidiasis, which is not an exceptional event.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Esophagitis; Female; Herpes Simplex; Humans; Immunocompetence

We report a case of acute herpetic esophagitis in a 33 year old man who was presumed to be immuno-compromised following prolonged steroid and cyclosporin treatment for acute rejection of a transplanted kidney. In Korea, all reported cases of herpetic esophagitis have been diagnosed in immuno-compromised and debilitated patients with a typical endoscopic appearance of ulcerating lesions. However, our patient showed multiple vesicular lesions without ulcer along the entire esophagus. The diagnosis was confirmed by colorimetric detection of herpes virus DNA using in situ hybridization. The endoscopic findings reported herein probably represent the typical early stage of acute herpetic esophagitis.

Topics: Acute Disease; Acyclovir; Adult; DNA, Viral; Esophagitis; Esophagoscopy; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompromised Host; In Situ Hybridization; Kidney Transplantation; Male

The various clinical presentations of infectious esophagitis have been discussed. The physician approach to patients with suspected infectious esophagitis is based on whether the patient has an underlying immune problem. Symptomatic patients with thrush and AIDS should be empirically treated but most other patients should be referred to endoscopy. Considering the AIDS epidemic, any patient without known immune deficiency who is diagnosed with infectious esophagitis should be screened for an immunodeficiency disorder.

Topics: Acyclovir; Adult; AIDS Serodiagnosis; AIDS-Related Opportunistic Infections; Esophagitis; Herpes Simplex; Herpesvirus 1, Human; HIV Seronegativity; Humans; Male

This paper describes five renal transplant recipients, out of a series of 221 consecutive patients, who developed herpes simplex esophagitis. This opportunistic infection presented as odyno- and/or dysphagia. It occurred during or shortly after treatment of acute cellular rejection episodes with high doses of steroids and, in four cases, of anti-lymphocyte globulins. The infection responded to acyclovir in all patients. We conclude from these observations that herpes esophagitis occurs during periods of intensive immunosuppression. Because its endoscopic manifestations are variable, biopsies and cultures are essential to reach the diagnosis. Prevention may be possible by avoiding transplantation from a seropositive donor to a negative recipient and by prophylactic oral acyclovir.

Topics: Acyclovir; Adult; Aged; Esophagitis; Esophagoscopy; Female; Graft Rejection; Herpes Simplex; Humans; Immunosuppressive Agents; Infusions, Intravenous; Kidney Transplantation; Middle Aged

A 41-year-old recipient of matched unrelated BMT acquired a severe mucocutaneous herpes simplex virus (HSV) type I infection during acyclovir prophylaxis. He was subsequently treated with high-dose acyclovir, but the HSV infection continued. In vitro analysis of the HSV isolate, obtained before and after the administration of high-dose acyclovir, demonstrated marked resistance to acyclovir but sensitivity to the antiviral agent foscarnet. The mucocutaneous HSV infection healed completely to a 16 day course of foscarnet. However, relapse of the acyclovir-resistant HSV infection occurred 202 days after the first foscarnet treatment but he responded again to a second foscarnet course. These data indicate that, with the rising frequency of acyclovir-resistant HSV infections observed in immunocompromised hosts, viral isolates should be tested for susceptibility to different antiviral drugs in recipients of BMT with recurrent or persistent HSV infections.

Topics: Acyclovir; Adult; Animals; Bone Marrow Transplantation; Chlorocebus aethiops; Esophagitis; Foscarnet; Herpes Simplex; Humans; Male; Recurrence; Simplexvirus; Transplantation, Homologous; Vero Cells

An immunocompetent 12-year-old boy had epigastric pain, odynophagia, fever, and hematemesis. Esophagoscopy demonstrated ulceration of his proximal and distal esophagus. Although histopathologic analysis of biopsies obtained from the lesions was nondiagnostic, herpes simplex virus type 1 was isolated from these samples. The patient responded rapidly to acyclovir therapy. Only a handful of cases of herpes esophagitis have been reported previously in immunocompetent children. This infection must be considered in children having odynophagia and fever, even if they are not immune compromised.

Topics: Acyclovir; Child; Esophagitis; Humans; Male; Simplexvirus

To determine the spectrum of esophageal disease responsible for dysphagia/odynophagia in AIDS patients not responding to current oral antifungals, we studied 49 consecutive patients whose esophageal symptoms failed to improve after a minimum of 3 wk of therapy with oral ketoconazole or fluconazole. An esophageal candidiasis resistant to oral antifungals was the most frequent disease found (22 single infections and four mixed with viruses). Viral esophagitis was identified in 13 cases (eight herpes simplex virus and five cytomegalovirus), and an esophagitis of unknown origin was documented in two patients. Other causes of symptoms included peptic esophagitis (four cases), esophageal stenosis (two cases), and Kaposi's sarcoma of the esophagus (one patient). Most patients with esophageal opportunistic infection experienced prompt relief of symptoms and complete endoscopic resolution on the specific antifungal (amphotericin B or fluconazole iv) or antiviral (acyclovir or gancyclovir iv) therapy, with the exception of those with concomitant fungal and viral infection who responded poorly to treatment. We conclude that most AIDS patients with dysphagia/odynophagia who do not respond to oral antifungals have an opportunistic infection of the esophagus. Nevertheless, specific antifungal or antiviral therapy is worthwhile, because it will eradicate, at least temporarily, the causative pathogens in most such patients.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Drug Resistance, Microbial; Esophagitis; Female; Fluconazole; Ganciclovir; Humans; Infusions, Intravenous; Ketoconazole; Male; Opportunistic Infections; Prospective Studies; Treatment Outcome

We report the case of a patient who developed herpes simplex oesophagitis less than one month after renal transplantation. Graft rejection treatment may have induced this infection. Diagnosis was suspected at endoscopy and was confirmed by biopsy. The patient was cured by intravenous acyclovir and temporary discontinuation of immunosuppressive medication.

Topics: Acyclovir; Esophagitis; Female; Herpes Simplex; Humans; Immunosuppressive Agents; Kidney Transplantation; Middle Aged

Clinically acquired acyclovir resistance in herpes simplex has usually been associated with a deficiency in viral thymidine kinase, which, in turn, has been linked with attenuated virulence in animal models. Diminished pathogenicity in thymidine kinase-deficient isolates has been partly responsible for controversies about the clinical significance of antiviral resistance. We report on a series of resistant virus isolates from a patient who had severe, progressive esophagitis. These isolates had various thymidine kinase activities, ranging from 2.8% to 130% when compared with the activity of the isolate obtained before treatment; the resistant isolate 615 retained enzyme activity as well as neurovirulence in an encephalitis model. Plaque purification showed a heterogeneous mixture containing at least one acyclovir-resistant, foscarnet-resistant plaque isolate (615.8) fully able to phosphorylate acyclovir. The 3.3-kbp BamHI fragment containing most of the DNA polymerase gene from isolate 615.8 was purified and used to successfully transfer both acyclovir and foscarnet resistance. Acquisition of in-vitro acyclovir resistance was associated with progression of clinical disease, as well as with maintenance of pathogenicity in an animal model and at least one mutation in viral DNA polymerase. Patients with herpes simplex infections that progress during acyclovir therapy should be observed for acquisition of resistance in the setting of antiviral chemotherapy; future studies should also consider the presence of heterogeneous virus populations in such patients.

Topics: Acyclovir; Adult; Animals; DNA-Directed DNA Polymerase; Drug Resistance, Microbial; Esophagitis; Female; Genes, pol; Herpes Simplex; Humans; Mice; Mutation; Simplexvirus; Thymidine Kinase; Virulence

Topics: Acyclovir; Esophagitis; Female; Herpes Simplex; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications

An 8 year-old, immunocompetent child developed a severe acute herpetic oesophagitis in the absence of oropharyngeal lesions. Intravenous treatment with the antiviral drug, acyclovir, relieved symptoms within 24 hours.

Topics: Acyclovir; Child; Esophagitis; Herpesviridae Infections; Humans; Male

9-(1,3-dihydroxy-2-propoxymethyl) guanine (ganciclovir) was used to treat 41 patients (median age, 37 years) with the acquired immunodeficiency syndrome and cytomegalovirus gastrointestinal infection. Sites of infection were the colon in 31, the esophagus in 5, the rectum in 4, and the small bowel in 1. Patients received ganciclovir, 5 mg/kg body weight, intravenously every 12 hours for 14 days. Clinical improvement was seen in 30 patients and virologic response in 32. Mainly hematologic toxicity occurred: moderate leukopenia (1000 to 1900/mm3) was seen in 7 patients and severe (less than 1000/mm3) in 1, and moderate neutropenia (500 to 1000/mm3) in 5 and severe (less than 500/mm3) in 1. A cutaneous rash developed in 2 patients. Median overall survival was 16 weeks (range, 2 to 56). Cytomegalovirus recurred in 13 patients; median time to recurrence was 9 weeks from the start of treatment. Ganciclovir may be effective in treating cytomegalovirus gastrointestinal disease in patients with the acquired immunodeficiency syndrome.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Colitis; Cytomegalovirus Infections; Digestive System Diseases; Esophagitis; Ganciclovir; Hematologic Diseases; Hormones; Humans; Intestine, Small; Male; Middle Aged; Prospective Studies; Rectal Diseases; Recurrence; Ulcer

Topics: Acute Disease; Acyclovir; Adult; Esophagitis; Esophagoscopy; Female; Humans; Immune Tolerance; Male; Virus Diseases

Topics: Acyclovir; Adult; Esophagitis; Herpes Simplex; Humans; Male

We describe a patient with the unusual complication of massive upper gastrointestinal bleeding secondary to herpetic esophagitis, whose bleeding persisted despite a vigorous antireflux regimen but who responded dramatically to intravenous acyclovir. The patient is reported to underscore the importance of considering herpetic infection of the esophagus as a cause of severe gastrointestinal bleeding so that appropriate therapy may be instituted.

Topics: Acyclovir; Esophagitis; Gastrointestinal Hemorrhage; Herpes Simplex; Humans; Immunosuppression Therapy; Middle Aged