Year 2025 / Volume 117 / Number 12
Letter
Two sides of the same coin: eosinophilic and herpetic esophagitis in an immunocompetent young adult

795-796

DOI: 10.17235/reed.2024.10839/2024

Sandra Correia, Tiago Pereira Guedes, Maria Mexia Leitão, Isabel Pedroto, Sílvia Barrias,

Abstract
Dear Editor, We report a case of a 30-year-old woman with an 8-year diagnosis of eosinophilic esophagitis (EoE) treated with swallowed fluticasone propionate throughout this period. She presented to the emergency room with a two-day history of severe odynophagia, aphagia, retrosternal pain, and fever. The patient was febrile and hemodynamically stable, with no visible oropharyngeal lesions. She presented with elevated C-reactive protein (37 mg/L). An esophagogastroduodenoscopy was performed, which revealed white plaque-like lesions with "volcano-like" shallow ulcerations with raised edges on the distal esophagus (Figure 1a&b). Multiple biopsies were taken from both the center and edges of the lesions. The patient was empirically started on intravenous fluconazole due to the suspicion of candida esophagitis. However, the patient's symptoms worsened over the next two days, and acyclovir at a dose of 5 mg/kg was started. The initial work-up showed a positive titer for Herpes Simplex Virus (HSV)-2 IgM (1.6 U/L) and a negative titer for IgG (2.24 U/L), as well as a negative serological study for HSV-1, cytomegalovirus, and human immunodeficiency virus (HIV). Histological examination revealed multinucleated giant cells with nuclear molding and chromatin margination and cells with "ground glass" nuclei, along with typical Cowdry type A intranuclear inclusion bodies and immunohistochemical staining for HSV type 2, confirmed the diagnosis of herpetic esophagitis (Figure 1c&d). The patient experienced rapid improvement and was discharged on oral acyclovir therapy at 400 mg/day, completing a total of 14 days of treatment with a total resolution of symptoms. 
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References
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Correia S, Guedes T, Leitão M, Pedroto I, Barrias S. Two sides of the same coin: eosinophilic and herpetic esophagitis in an immunocompetent young adult. 10839/2024


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Publication history

Received: 05/10/2024

Accepted: 08/10/2024

Online First: 18/10/2024

Published: 12/12/2025

Article Online First time: 13 days

Article editing time: 433 days


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