Total dysphagia after short course of systemic corticotherapy: herpes simplex virus esophagitis

A 72 year-old female developed a herpetic esophagitis after 3 d of oral corticotherapy for an acute exacerbation of chronic obstructive pulmonary disease, presenting as odynophagia and total dysphagia. Biopsies were taken during a first esophagogastroduodenoscopy (EGD) and the patient was referred to the thoracic surgery service with a presumptive diagnosis of esophageal cancer. A second EGD was planned for dilatation, but by that time the stenosis was completely resolved. The biopsies taken during the first EGD revealed multiple herpetic viral inclusions and ulcerations without any dysplasia or neoplasia. In front of a severe esophageal stenosis, one must still exclude the usual differential diagnosis peptic stenosis and cancer. Visualization of endoscopic lesions can suggest the diagnosis but must be promptly confirmed by biopsy, viral culture or polymerase chain reaction. Although immune systemic effects of corticotherapy are well known and herpetic esophagitis occurs most frequently in immunocompromised individuals, this case emphasizes the importance of clinical awareness concerning short courses of corticotherapy for immunocompetent individuals. This article discusses the reactivation process of herpetic infection in this context and addresses its diagnostic and therapeutic issues.