Images in Clinical Medicine
Herpes Simplex Esophagitis
N Engl J Med 1999; 340:1254April 22, 1999
- Article
Figure 1 A 47-year-old woman with a history of hypertension and alcohol abuse had had fatigue, nausea, vomiting, and abdominal pain for two days. On admission, she vomited coffee-grounds material. The blood pressure, measured while she was upright, was 80/50 mm Hg. Examination revealed no fever or lesions of the mouth. The patient had epigastric tenderness, but the bowel sounds were normal and there was no rebound tenderness. The serum amylase level was 244 U per liter, the serum lipase level was 5922 calcium level was 3.1 mmol per liter, and the serum bicarbonate level was 19 mmol per liter. Treatment with intravenous fluids, ranitidine, meperidine, and bowel rest improved the patient's condition. Because she had vomited blood, esophagogastroduodenoscopy was performed and revealed severe esophagitis and gastritis. There were inflammatory exudates, ulcerations, and associated granulation tissue in the proximal, middle, and distal portions of the esophagus (Panel A). Biopsy demonstrated multinucleated giant cells consistent with the presence of herpetic esophagitis (Panel B; hematoxylin and eosin, ×1000). The patient had no symptoms of esophagitis or dyspepsia. She was negative for human immunodeficiency virus and had no evidence of any immunodeficiency state. She was treated with oral acyclovir for 14 days and remained hospitalized for several weeks for complications of pancreatitis. When seen six months later at follow-up, she had no abdominal pain, dysphagia, or dyspepsia and was eating normally.
Frank L. Urbano, M.D.
Partners in Primary Care, Medford, NJ 08055Minhhuyen T. Nguyen, M.D.
Graduate Hospital, Philadelphia, PA 19146
