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Herpes simplex virus esophagitis—clinical challenges in the elderly
  1. Sara Fernandes Custódio1,
  2. Catarina Félix2,
  3. Fátima Cruz1 and
  4. Manuela Zita Veiga3
  1. 1Department of Otorhinolaryngology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  2. 2Department of Gastroenterology, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  3. 3Department of Internal Medicine, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Egas Moniz, Lisboa, Portugal
  1. Correspondence to Sara Fernandes Custódio; saracustodio1{at}gmail.com

Abstract

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.

  • infection (gastroenterology)
  • ear
  • nose and throat/otolaryngology
  • geriatric medicine

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Footnotes

  • Contributors All the authors contributed to the diagnosis and management of the clinical case. The article was written by SFC, with an important contribution of CF, FC and MZV.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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