Herpetic esophagitis in a young immunocompetent patient: an unusual cause of severe odynophagia. A case report.

Abstract

Introduction: Herpetic esophagitis is a rare cause of severe odynophagia associated with immunocompromised patients, although cases have also been reported in young immunocompetent individuals.

Case Presentation: A 19-year-old woman presented with a five-day history of retrosternal pain and odynophagia, with near-complete inability to tolerate oral intake. She was initially treated for tonsillitis without improvement. Examination revealed a mildly hyperemic oropharynx, and laboratory tests showed elevated acute-phase reactants. Upper gastrointestinal endoscopy revealed multiple superficial serpentine ulcers in the middle and proximal esophagus, and fibrinous erosions at the esophagogastric junction. Biopsies were taken from the margins and base of the ulcers. Empirical treatment with oral acyclovir was initiated, resulting in complete clinical resolution after seven days. Histological examination and detection of HSV-1 in the biopsy confirmed the diagnosis of herpetic esophagitis in an immunocompetent patient.

Discussion: Herpetic esophagitis should be considered in the differential diagnosis of severe odynophagia and retrosternal pain in immunocompetent young adults. The typical endoscopic pattern of small ulcers with preserved adjacent mucosa guides the diagnosis, which must be confirmed by histopathological examination and viral detection techniques. Early treatment with acyclovir accelerates symptom resolution and reduces the risk of complications, with an excellent prognosis in immunocompetent patients.

Keywords: herpetic esophagitis, odynophagia, herpes simplex virus, immunocompetent, gastrointestinal endoscopy.