Año 2025 / Volumen 117 / Número 12
Carta
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,

Resumen
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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Bibliografía
[1] Canalejo E, García Durán F, Cabello N, García Martínez J. Herpes Esophagitis in Healthy Adults and Adolescents. Medicine 2010;89:204–10. https://doi.org/10.1097/MD.0b013e3181e949ed.
[2] Ramanathan J, Rammouni M, Baran J, Khatib R. Herpes simplex virus esophagitis in the immunocompetent host: an overview. Am J Gastroenterol 2000;95:2171–6. https://doi.org/10.1111/j.1572-0241.2000.02299.x.
[3] Monsanto P, Almeida N, Cipriano MA, Gouveia H, Sofia C. Concomitant herpetic and eosinophilic esophagitis--a causality dilemma. Acta Gastroenterol Belg 2012;75:361–3. PMID: 23082710
[4] Lindberg GM, Van Eldik R, Saboorian MH. A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis. Nat Clin Pract Gastroenterol Hepatol 2008;5:527–30. https://doi.org/10.1038/ncpgasthep1225.
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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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Ficha Técnica

Recibido: 05/10/2024

Aceptado: 08/10/2024

Prepublicado: 18/10/2024

Publicado: 12/12/2025

Tiempo de prepublicación: 13 días

Tiempo de edición del artículo: 433 días


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