Abstract
The commonest type of viral esophagitis is herpetic esophagitis. It is generally seen in the immunocompromised patients with underlying malignancy, AIDS or taking immunosuppressive therapy. However, it has also been reported in the immunocompetent individual. Endoscopical findings can suggest candidiasis or can be confused with malignancy. In this report we will present histopathological features of herpetic esophagitis, which can display different clinical pictures, in two cases. Fifty one year old-male patient using inhaler steroid for 3 months because of bronchiolitis obliterans presented with dysphagia. Endoscopic investigation revealed large ulcers at the distal end of Z-line. The second case is 56 year-old female patient taking hemodialysis treatment for 3 years because of lupus nephritis. The patient who had been treated with oral steroid for 2 months presented with dysphagia. Endoscopic investigation revealed multiple ulcers with hemorrhagic foci throughout the esophagus. In both cases histopathologically several epithelial cells containing intranuclear inclusions surrounded with clear halo, intermixed with multinuclear giant cells and dense mixed type inflammatory cells are detected. No evidence of malignancy has been detected. The cases have been given a diagnosis of herpetic esophagitis. Since immunocompetent cases as well as immunocompromised patients presenting with dysphagia can have herpetic esophagitis, and ulcers which can be confused with malignancy can be seen in this disorder, this diagnosis should be kept in mind in differential diagnosis
Keywords
References
- Itoh T, Takahashı T, Kusaka K, et al. Herpes simplex esophagitis from 1307 autopsy cases. J Gastroenterol Hepatol 2003, 18:1407–11.
- Takubo K. Viral Esophagitis. In: Pathology of the Esophagus. 2’nd ed, Hong Kong, Springer, 2007, pp. 58-60.
- Lambert H, Eastham EJ. Herpes oesophagitis in a healthy 8 year-old child. Arch Dis Child. 1987, 62: 301-2.
- Kato S, Yamamoto R, Yoshimitsu S, et al. Herpes simplex esophagitis in the immunocompetent host. Diseases of the Esophagus 2005, 18: 340–344.
- Canalejo E, Dura´n FG, Cabello N, Martı´nez JG. Herpes Esophagitis in Healthy Adults and Adolescents Report of 3 Cases and Review of the Literature. Medicine 2010, 89: 204-10.
- Wiest PA, Flanigan T, Salata RA, Shlaes DM, Katzman M, Ledennan MM. Serious Infectious Complications of Corticosteroid Therapy for COPD. Chest 1989, 95: 1180-4.
- Rahhal RM, Ramkumar DP, Pashankar DS. Simultaneous Herpetic and Candidal Esophagitis in an Immunocompetent Teenager. Journal of Pediatric Gastroenterology and Nutrition 2005, 40: 371–373.
- Lee B, Caddy G. A rare cause of dysphagia: Herpes simplex esophagitis. World J Gastroenterol 2007, 13: 2756-7.
- Robertson AGN, Dunn LJ, Immanuel A, Griffin SM. An unusual presentation of herpes simplex esophagitis: a nonhealing “peptic” ulcer. Endoscopy 2009, 41: E213. DOI: 10.1055/s-0029-1214687
Abstract
Herpetik özofajit en sık rastlanan viral özofajittir. Genellikle malignite veya AIDS hastaları ile immünsüpresif tedavi alan immünyetmezlikli hastalarda görülür ancak immünyetmezliği olmayan hastalarda da bildirilmiştir. Endoskopik görünümü kandidiazis düşündürebileceği gibi maligniteyle karışabilir. Bu farklı klinik tabloları sergileyen herpetik özofajitte histopatolojik özellikler iki olgu ile sunulacaktır. Bronşiolitis obliterans nedeniyle inhaler steroid kulanmaya başladıktan 3 hafta sonra yutma güçlüğü nedeniyle başvuran elli bir yaşında erkek hastada endoskopik değerlendirmede özofagus Z-çizgisi distalinde geniş ülserler görüldü. İkinci olgu lupus nefritine bağlı kronik böbrek yetmezliği nedeniyle 3 yıldır hemodiyaliz tedavisi alan elli altı yaşında kadın hastadır. Son iki aydır oral steroid kullanan hastanın yutma güçlüğü olması nedeniyle endoskopi uygulandı. Tüm özofagusta hemoraji odakları içeren ülserler saptandı. Her iki olguda biyopsilerde kısmen ülsere özofageal skuamöz epiteli de infiltre eden yoğun karışık tipte iltihap hücreleri ve multinükleer dev hücreler arasında halo ile çevrili intranükleer inklüzyonlar içeren epitelyal hücreler görüldü. Malignite düşündürecek bulgu görülmedi, olgular herpetik özofajit olarak kabul edildi. İmmünyetmezlikli hastalarda olduğu gibi immünyetmezliği olmayan hastalarda da görülebileceğinden ve endoskopik olarak maligniteyle karışabilecek ülserlere neden olduğundan yutma güçlüğü olan hastalarda herpes simpleks özofajiti ayırıcı tanıda akla gelmelidir
Keywords
References
- Itoh T, Takahashı T, Kusaka K, et al. Herpes simplex esophagitis from 1307 autopsy cases. J Gastroenterol Hepatol 2003, 18:1407–11.
- Takubo K. Viral Esophagitis. In: Pathology of the Esophagus. 2’nd ed, Hong Kong, Springer, 2007, pp. 58-60.
- Lambert H, Eastham EJ. Herpes oesophagitis in a healthy 8 year-old child. Arch Dis Child. 1987, 62: 301-2.
- Kato S, Yamamoto R, Yoshimitsu S, et al. Herpes simplex esophagitis in the immunocompetent host. Diseases of the Esophagus 2005, 18: 340–344.
- Canalejo E, Dura´n FG, Cabello N, Martı´nez JG. Herpes Esophagitis in Healthy Adults and Adolescents Report of 3 Cases and Review of the Literature. Medicine 2010, 89: 204-10.
- Wiest PA, Flanigan T, Salata RA, Shlaes DM, Katzman M, Ledennan MM. Serious Infectious Complications of Corticosteroid Therapy for COPD. Chest 1989, 95: 1180-4.
- Rahhal RM, Ramkumar DP, Pashankar DS. Simultaneous Herpetic and Candidal Esophagitis in an Immunocompetent Teenager. Journal of Pediatric Gastroenterology and Nutrition 2005, 40: 371–373.
- Lee B, Caddy G. A rare cause of dysphagia: Herpes simplex esophagitis. World J Gastroenterol 2007, 13: 2756-7.
- Robertson AGN, Dunn LJ, Immanuel A, Griffin SM. An unusual presentation of herpes simplex esophagitis: a nonhealing “peptic” ulcer. Endoscopy 2009, 41: E213. DOI: 10.1055/s-0029-1214687
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | September 1, 2012 |
| Published in Issue | Year 2012Issue: 3 |