Department of Gastroenterology, Endoscopy Unit, Clínica Universidad de Navarra. Pamplona, Spain.
Rev Esp Enferm Dig. 2012 Apr;104(4):214-7. doi: 10.4321/s1130-01082012000400009.
Herpetic esophagitis in immunocompetent individuals is a rare entity that should be suspected clinically by an acute onset of symptoms, and without apparent cause of a symptomatic triad consisting on odynophagia, heartburn and fever. Its occurrence may be due to reactivation of a previous infection or less often a primary infection. Herpes simplex type 1 is the most common cause. Upper endoscopy establishes the diagnosis of suspicion of herpetic esophagitis. It also allows to take multiple biopsy samples and viral culture, leading to a definitive diagnosis. The severity of symptoms is related to the degree of oesophageal involvement. In immunocompromised patients treatment is indicated with acyclovir, but the indication in immunocompetent patients is controversial because the process is time, limited with a low probability of complications. We present a case of acute herpetic esophagitis in an immunocompetent host that debuted acutely with severe upper gastrointestinal tract symptoms, associated with an insidious and nonspecific onset of flu-like symptoms. Endoscopic findings showed a severe involvement in the lower third of the oesophageal mucosa.
免疫功能正常个体的疱疹性食管炎是一种罕见的疾病，其临床特征为急性发作症状，且无明显的三联征症状（即吞咽困难、烧心和发热）病因。其发生可能是由于先前感染的复发，或较少见的原发性感染。单纯疱疹病毒 1 型是最常见的原因。上消化道内镜检查可怀疑诊断疱疹性食管炎。它还可以进行多次活检和病毒培养，从而做出明确诊断。症状的严重程度与食管受累的程度有关。在免疫功能低下的患者中，阿昔洛韦治疗是指征，但在免疫功能正常的患者中，由于病程是自限性的，并发症的概率较低，因此治疗的指征存在争议。我们报告了一例免疫功能正常宿主的急性疱疹性食管炎，其急性发作伴有严重的上消化道症状，并伴有隐匿和非特异性的流感样症状。内镜检查发现食管下段黏膜严重受累。
