A 61-year-old man suffered from upper abdominal discomfort and appetite loss. He had underwent surgery of pharyngeal cancer the year before at the other hospital. Endoscopic examinations of upper gastrointestinal tract and colon revealed no abnormal findings. The patient also felt lower abdominal pain and had appendectomy next year. However, discomfort and pain on upper and lower abdomen unchanged and his fecal occult blood test was positive, he visited our hospital to survey metastasis of pharynx cancer by capsule endoscopy. The patient was nutritionally depleted, but immunologically unaffected. Capsule endoscopy showed multiple erosions and ulcers on small intestine. This time, upper abdominal endoscopy demonstrated geographical ulcers and erosions on esophageal mucosa. The biopsy specimens of the esophagus showed “ground glass” nuclei and positively immunostained with anti-herpes simplex virus antibody. According to nutritional improvement, the ulcers of esophagus disappeared endoscopically, together with a relief of upper abdominal discomfort. Simultaneously, the lower abdominal pain resolved and it was speculated that small intestinal lesions were also herpes simplex virus-associated. Because herpes simplex virus could affect all gastrointestinal tract, and the ulcers on capsule endoscopy resembled those on upper gastrointestinal endoscopy, aggressive endoscopic examinations are recommended, especially with longstanding symptom in the abdomen.
