Herpetic Esophageal Ulcer in an Immunocompromised Host

Herpetic esophagitis is a rare condition that occurs predominantly in immunocompromised patients. Diagnosis is based on the macroscopic findings of upper gastrointestinal endoscopy, with confirmation by histopathological examination and molecular testing (PCR). Intravenous acyclovir remains the treatment of choice. We report a case of an isolated herpetic esophageal ulcer in a patient with Crohn’s disease and a newly diagnosed retroviral infection, who was admitted to our department for the initial evaluation of Crohn’s disease. The diagnosis of herpetic esophagitis was suspected in the presence of odynophagia, high-grade fever (39°C), and marked deterioration of the general condition. Upper gastrointestinal endoscopy revealed a solitary superficial ulcer located in the middle third of the esophagus. HIV serology subsequently returned positive. Histopathological examination and tissue PCR confirmed the diagnosis of herpetic esophagitis. The patient was treated with intravenous acyclovir, with a favorable clinical outcome.