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Odynophagia in a young adult: revisiting herpetic esophagitis and eosinophilic esophagitis
  1. Hiral Patel1,
  2. Samantha Minh Thy Nguyen1,
  3. Aaisha Haque2 and
  4. Guha Krishnaswamy2,3
  1. 1Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA
  3. 3Department of Medicine, Section on Pulmonary, Critical Care, Allergy and Clinical Immunology, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Guha Krishnaswamy; gkrishna{at}wakehealth.edu

Abstract

An immunocompetent man in his 20s presented with a 24-hour history of severe odynophagia, nausea, vomiting and throat pain. Esophagogastroduodenoscopy (EGD) revealed severe esophagitis with ulcerated mucosa, exudative debris, haemorrhage and multiple erosions. Biopsy of the oesophageal tissue demonstrated marginated chromatin, multinucleated giant cells and molding of nuclei, consistent with herpes simplex virus esophagitis (HSE). Treatment with oral acyclovir led to the complete resolution of symptoms. The patient subsequently developed dysphagia again, 8 months later. EGD showed furrowing and concentric rings typical of eosinophilic esophagitis (EoE), a diagnosis confirmed by biopsy. Treatment with a proton pump inhibitor and swallowed topical corticosteroids led to symptomatic improvement. Thus, HSE can occur in immunocompetent hosts and on occasion, HSE may be a harbinger of EoE, as evidenced by our extensive literature review. Mechanical disruption of the mucosal barrier by viruses, facilitating food allergen penetration, and associated immunological signaling abnormalities may be responsible phenomena requiring further elucidation.

  • Gastrointestinal system
  • Infection (gastroenterology)
  • Immunology

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Footnotes

  • Contributors HP wrote the first draft and did literature research. The conception and design of the case report were conducted by HP and SMTN. The article was critically revised for publication by HP, SMTN, AH and GK. The patient was treated by GK. GK was responsible for the generation of figures, figure legends, figure 3 (mechanism) and discussion of molecular mechanisms. GK restructured the abstract and ovresaw the organization of the entire manuscript, carrying out detailed editing and proof reading through many interations.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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