Herpes simplex esophagitis: Report of 4 pediatric cases in immunocompetent patients

Abstract

Although herpetic infection is considered in the differential diagnosis of a patient who is immunocompromised with esophagitis, it is less thought of in the immunocompetent patient. There are few reports of esophagitis caused by herpes simplex virus in immunocompetent children and adolescents. We are reporting four cases in this age group who have been identified to have herpes simplex esophagitis. The first patient was nine-year-old boy who presented with chest pain, fever, and diarrhea. The second patient was a six-year-old boy who presented severe chest pain and had a negative endoscopy four months prior. The third was an 18-year-old young man with history of vomiting, odynophagia, and recent weight loss of 25 lbs. The fourth patient was a six-year-old girl admitted for dehydration and febrile illness three days after tonsillectomy, complaining of chest pain and epigastric abdominal.Their endoscopic findings varied from punched-out ulceration only to erosive esophagitis or both. They were all diagnosed by PCR analysis and not by pathology. All had biopsies suggestive of esophagitis. They all responded well to acyclovir. Based on testing and available follow up, all patients appeared to be immunocompetent, although one case refused HIV testing. Herpes simplex esophagitis in children can have variable presentations. High level of suspicion is warranted even in the immunocompetent patient. This is especially important when the history of acute gastrointestinal symptoms includes a triad of fever, chest pain, and odynophagia, but also even if these symptoms are recurrent. Viral cultures and PCR of the esophageal biopsies should be performed in addition to pathology looking for Cowdry Type A bodies.