Clin Endosc.  2019 Nov;52(6):606-611. 10.5946/ce.2019.021.

A Case of Eosinophilic Esophagitis Associated with Herpes Esophagitis in a Pediatric Patient

• Kim J
• Lee K
• Lee W

• KMID: 2465804
• DOI: http://doi.org/10.5946/ce.2019.021

Abstract

Eosinophilic esophagitis is a rare disease in Asian countries, but its incidence is growing rapidly in Western countries. The main pathophysiology of eosinophilic esophagitis is esophageal epithelial barrier dysfunction; disruption of the esophageal epithelial barrier easily induces antigen sensitization to foods and aeroallergens, which leads to subsequent esophageal inflammation as a result of eosinophil recruitment. Here we report a case of an 11-year-old Korean boy who suffered from fever, odynophagia, dysphagia, and chest pain. His upper endoscopic findings showed longitudinal ulcers with a volcano-like appearance at the distal esophagus. Polymerase chain reaction test results and biopsy specimens were positive for herpes simplex virus type 1. He was treated with acyclovir and a proton pump inhibitor, but his follow-up endoscopy showed typical patterns of eosinophilic esophagitis, and the biopsy specimens were compatible with the diagnostic criteria for eosinophilic esophagitis. Therefore, we report a very rare case of eosinophilic esophagitis after herpes esophagitis in a Korean child with normal immunity.

Keyword

Child; Eosinophilic esophagitis; Herpes simplex virus

MeSH Terms

Acyclovir
Asian Continental Ancestry Group
Biopsy
Chest Pain
Child
Deglutition Disorders
Endoscopy
Eosinophilic Esophagitis*
Eosinophils*
Esophagitis*
Esophagus
Fever
Follow-Up Studies
Herpesvirus 1, Human
Humans
Incidence
Inflammation
Male
Polymerase Chain Reaction
Proton Pumps
Rare Diseases
Simplexvirus
Ulcer
Acyclovir
Proton Pumps

Figure

• 

  Fig. 1. (A) Longitudinal ulcers with raised margins, yellow bases with a volcano-like appearance on the distal esophagus (black ellipses), and ulcers on the lip are shown. (B) The initial esophageal biopsy specimen shows nonspecific inflammatory and ulcerative findings without cytopathic changes or intranuclear inclusions (hematoxylin and eosin stain, ×200). The polymerase chain reaction test is positive for herpes simplex virus (HSV) 1; patient (P), positive control (PC), and negative control (NC).

• 

  Fig. 2. (A) After acyclovir treatment, although the middle and distal esophagus shows improvement in mucosal edema and ulcers, the distal esophagus still shows ulceration with scarring. (B) The post-treatment biopsy specimen shows an improvement in inflammation, and the herpes simplex virus (HSV) type 1 polymerase chain reaction test shows a negative change. P, patient; PC, positive control; NC, negative control.

• 

  Fig. 3. (A) The follow-up endoscopy after acyclovir and proton pump inhibitor treatment shows multiple white exudates and moderate mucosal edema with furrows in the proximal esophagus. (B) The distal esophagus shows multiple longitudinal furrows with loss of mucosal vascularity. (C) The distal esophageal biopsy specimen from the follow-up endoscopy shows massive intraepithelial eosinophilic infiltration (up to 200 per high power field) and subepithelial fibrosis (hematoxylin and eosin stain, ×200).

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