2019 Volume 61 Issue 10 Pages 2346-2352
A healthy 13-year-old male with fever, postprandial chest pain and anorexia was diagnosed with bronchitis by his family doctor and received antibiotic therapy for seven days. The symptoms did not improve, and he was referred to our hospital. Endoscopy revealed a small erosion and a sharply demarcated, punched-out, circular ulcer in the middle esophagus, and many longitudinal confluent ulcers in the distal esophagus. Histological examination of the esophageal biopsy specimens showed inflammation and giant cells with nuclear enlargement and ground-glass nuclei in epithelial cells. Immunohistochemical staining for herpes simplex virus (HSV) antibody was positive. Serologically, he was positive for anti-HSV immunoglobulin (Ig) M and negative for anti-HSV IgG at the time of the first visit. However, anti-HSV-IgG showed seroconversion during the recovery period. We diagnosed herpes esophagitis caused by primary HSV infection in this healthy child. Herpes esophagitis by primary HSV infection is rare, because it is considered that herpes esophagitis is usually caused by recurrent HSV infection in an immunocompromised or debilitated host. After administration of valacyclovir for 7 days, his symptoms and endoscopic findings promptly improved.
