Case of Primary and Secondary Herpes Esophagitis in a Healthy Immunocompetent 22-Year -Old Female

Abstract

Herpes esophagitis is commonly seen in immunocompromised individuals, but it is rare to find in an immunocompetent individual. A previously healthy 22-year-old female presented to the emergency room with a 2-day history of fever, dysphagia, odynophagia, and substernal chest pain worsened with swallowing. She has a previous history of eosinophilic esophagitis. Although she denies history of oral or genital herpes, her boyfriend had a cold sore 1 week prior to presentation. Her physical exam was unremarkable other than temperature of 100.5 and tachycardia up to 149BPM. Laboratory studies only demonstrated WBC 14, bands 6%, and monocytes 15. EGD demonstrated severe ulceration throughout the entire esophagus, and biopsy demonstrated viral cytopathic effects of herpes. Immunohistochemistry confirmed HSV-1. The patient was treated with IV acyclovir and discharged 3 days later on oral acyclovir. Repeat EGDs at 2 and 7 months demonstrated no ulceration and HSV was negative by immunohistochemistry. Eleven months after the initial presentation, the patient returned to the emergency room with 3 days of worsening fever, dysphagia, odynophagia, and substernal chest pain worsened with swallowing. EGD demonstrated ulceration from mid to distal esophagus and biopsy confirmed HSV-1 by immunohistochemistry. The patient was again treated with IV acyclovir followed by oral acyclovir at discharge. There was no evidence of immunosuppression and testing for HIV was negative. After a literature review, we were only able to find two suspected herpes esophagitis cases that were unsure to have been a primary or secondary outbreak in an immunocompetent individual. Here, we present the first known case of primary and secondary herpes esophagitis in an immunocompetent individual.