University of Arkansas for Medical Sciences Fayetteville, AR
Sahil Sabharwal, MD1, Brandyn Young, BS1, Deepak Sabharwal, MS2, Sarah Assem, MD1, Kristen Brandon, MD1, Terryl Ortego, MD3 1University of Arkansas for Medical Sciences, Fayetteville, AR; 2Health Orlando Incorporated, Orlando, FL; 3Mercy Hospital, Rogers, AR Introduction: Herpes Simplex Esophagitis (HSE) is a viral infection of the esophagus caused primarily by HSV-1, typically affecting immunocompromised individuals. It presents with symptoms such as odynophagia, dysphagia, and chest pain, and is diagnosed through endoscopy and histopathology revealing multinucleated giant cells with intranuclear inclusions. Conversely, Eosinophilic Esophagitis (EoE) is a chronic, immune-mediated condition marked by eosinophilic infiltration of the esophageal mucosa, often associated with atopic diseases. Though both conditions are independently recognized causes of esophagitis, recent literature suggests a potential association between them, even in immunocompetent patients. Epithelial disruption in EoE may predispose the esophagus to viral infection, while HSE could provoke eosinophilic inflammation. This report explores the rare coexistence of HSE and EoE in an immunocompetent individual.
Case Description/
Methods: An 18-year-old male with a history of asthma presented with odynophagia, dysphagia to solids, and occasional acid reflux. He reported a history of childhood food allergies, with current milk allergy being the only persistent one. No prior esophageal evaluations were noted, and family history was noncontributory. Initial treatment with an 8-week proton pump inhibitor (PPI) and a 5-day steroid course led to symptom relief. An esophagogastroduodenoscopy (EGD) showed LA Grade B reflux esophagitis. Histopathological examination of biopsies revealed findings consistent with both HSE and EoE (figure 1 and 2). Treatment was initiated with antiviral therapy for HSE, followed by plans for EoE management. Discussion: This case highlights the diagnostic and therapeutic complexity of concurrent HSE and EoE in an immunocompetent host. Shared symptoms such as dysphagia and odynophagia can obscure the dual pathology. Accurate diagnosis requires careful endoscopic and histological evaluation to distinguish HSE's viral cytopathic changes from EoE's eosinophilic inflammation. The sequence of therapeutic interventions is critical, with viral management typically prioritized. This dual presentation underscores the importance of considering coexisting etiologies in esophagitis and may prompt further investigation into the bidirectional relationship between viral infection and eosinophilic inflammation. Heightened awareness and additional research may enhance diagnostic accuracy and therapeutic outcomes in similar complex presentations.
Disclosures: Sahil Sabharwal indicated no relevant financial relationships. Brandyn Young indicated no relevant financial relationships. Deepak Sabharwal indicated no relevant financial relationships. Sarah Assem indicated no relevant financial relationships. Kristen Brandon indicated no relevant financial relationships. Terryl Ortego indicated no relevant financial relationships.
Sahil Sabharwal, MD1, Brandyn Young, BS1, Deepak Sabharwal, MS2, Sarah Assem, MD1, Kristen Brandon, MD1, Terryl Ortego, MD3. P2845 - Intersecting Pathologies: Herpes Simplex Esophagitis and Eosinophilic Esophagitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
