Herpes esophagitis

Last revised by Peter Zuidewind on 2 Nov 2023

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

Herpes esophagitis occurs as an opportunistic infection in immunocompromised patients, particularly those with AIDS. It has occasionally 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.

Herpes esophagitis 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, Herpes esophagitis 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 including:

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