Herpes oesophagitis. I. Light microscopical and immunohistochemical investigations.

The diagnosis of herpes oesophagitis was established from routinely processed biopsy specimens and cytological brush preparations of six patients by immunoperoxidase staining of herpes simplex virus (HSV)-antigen. Macroscopically small round punched-out ulcers are the most frequent and characteristic feature of herpes oesophagitis, whether occurring in patients with serious debilitating illnesses, under immunosuppression, or without evidence of any significant disease. Light microscopically the herpetic changes of squamous epithelium consist of ballooning degeneration, ground glass nuclei with margination of chromatin, eosinophilic inclusions and multinuclear giant cells. A specific positive reaction with anti-HSV is found only at the borders of the oesophageal ulcers. The immunostaining intensity of nuclei and cytoplasm varies from cell to cell according to the mode of HSV replication in productive infected cells. The latency of HSV in the vagus ganglion and centrifugal neural spread are discussed.