Affiliations: Department of Pediatrics, Hurley Medical Center,
Flint, MI, USA | Department of Research, Hurley Medical Center, Flint,
MI, USA
Note: [] Correspondence: Walid Abuhammour, MD, Department of Pediatrics,
One Hurley Plaza, Hurley Medical Center, Flint, MI 48503, USA. Tel.: +1 810 262
7280; Fax: +1 810 262 9736; E-mail: wabuham1@hurleymc.com
Abstract: Although herpetic infection is considered in the differential
diagnosis of a patient who is immunocompromised with esophagitis, it is less
thought of in the immunocompetent patient. There are few reports of esophagitis
caused by herpes simplex virus in immunocompetent children and adolescents. We
are reporting four cases in this age group who have been identified to have
herpes simplex esophagitis. The first patient was nine-year-old boy who presented with chest
pain, fever, and diarrhea. The second patient was a six-year-old boy who
presented severe chest pain and had a negative endoscopy four months prior. The
third was an 18-year-old young man with history of vomiting, odynophagia, and
recent weight loss of 25 lbs. The fourth patient was a six-year-old girl
admitted for dehydration and febrile illness three days after tonsillectomy,
complaining of chest pain and epigastric abdominal.Their endoscopic findings
varied from punched-out ulceration only to erosive esophagitis or both. They
were all diagnosed by PCR analysis and not by pathology. All had biopsies
suggestive of esophagitis. They all responded well to acyclovir. Based on
testing and available follow up, all patients appeared to be immunocompetent,
although one case refused HIV testing. Herpes simplex esophagitis in children
can have variable presentations. High level of suspicion is warranted even in
the immunocompetent patient. This is especially important when the history of
acute gastrointestinal symptoms includes a triad of fever, chest pain, and
odynophagia, but also even if these symptoms are recurrent. Viral cultures and
PCR of the esophageal biopsies should be performed in addition to pathology
looking for Cowdry Type A bodies.
