Herpes esophagitis

Last revised by Calum Worsley on 28 Oct 2022

Herpes esophagitis is one of the infectious esophagitis that usually affects immunocompromised patients. 

It occurs as an opportunistic infection in immunocompromised patients, particularly those with AIDS. It has also been described in immunocompetent individuals 3.

The etiological agent is the herpes simplex virus (HSV), which is a double-stranded DNA virus classified into two subtypes: HSV-1 and HSV-2.

It can be a consequence of viremia, reactivation of HSV, or even a direct spread of the virus to esophageal mucosa from the vagus nerve in immunocompromised patients. The definitive diagnosis is made with endoscopic biopsy 1

On double contrast studies, it manifests as multiple small (<1 cm) punctate or linear ulcers with surrounding radiolucent halo. It has a predilection for the middle third of the esophagus 4.

It is considered a self-limited condition and expected to resolve within two weeks, only managed with symptomatic treatment 1.

Other causes of infectious esophagitis:

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Cases and figures

  • Figure 1: histology
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