{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T19:58:28Z","timestamp":1781553508572,"version":"3.54.5"},"reference-count":34,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,10,28]]},"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>An immunocompetent man in his 20s presented with a 24-hour history of severe odynophagia, nausea, vomiting and throat pain. Esophagogastroduodenoscopy (EGD) revealed severe esophagitis with ulcerated mucosa, exudative debris, haemorrhage and multiple erosions. Biopsy of the oesophageal tissue demonstrated marginated chromatin, multinucleated giant cells and molding of nuclei, consistent with herpes simplex virus esophagitis (HSE). Treatment with oral acyclovir led to the complete resolution of symptoms. The patient subsequently developed dysphagia again, 8 months later. EGD showed furrowing and concentric rings typical of eosinophilic esophagitis (EoE), a diagnosis confirmed by biopsy. Treatment with a proton pump inhibitor and swallowed topical corticosteroids led to symptomatic improvement. Thus, HSE can occur in immunocompetent hosts and on occasion, HSE may be a harbinger of EoE, as evidenced by our extensive literature review. Mechanical disruption of the mucosal barrier by viruses, facilitating food allergen penetration, and associated immunological signaling abnormalities may be responsible phenomena requiring further elucidation.<\/jats:p>","DOI":"10.1136\/bcr-2022-251238","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T10:00:25Z","timestamp":1668160825000},"page":"e251238","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Odynophagia in a young adult: revisiting herpetic esophagitis and eosinophilic esophagitis"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4636-3002","authenticated-orcid":false,"given":"Hiral","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha Minh Thy","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaisha","family":"Haque","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9848-6197","authenticated-orcid":false,"given":"Guha","family":"Krishnaswamy","sequence":"additional","affiliation":[{"name":"Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA"},{"name":"Department of Medicine, Section on Pulmonary, Critical Care, Allergy and Clinical Immunology, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,11,11]]},"reference":[{"key":"2025082700385283000_15.11.e251238.1","unstructured":"Feldman M , Friedman LS , Sleisenger MH . Sleisenger & Fordtran\u2019s gastrointestinal and liver disease: pathophysiology, diagnosis, management. Philadelphia: Saunders, 2002."},{"key":"2025082700385283000_15.11.e251238.2","first-page":"567","article-title":"Infectious esophagitis","volume":"2","author":"Wilcox","year":"2006","journal-title":"Gastroenterol Hepatol"},{"key":"2025082700385283000_15.11.e251238.3","doi-asserted-by":"crossref","first-page":"3011","DOI":"10.3748\/wjg.v23.i17.3011","article-title":"Esophagitis and its causes: Who is \"guilty\" when acid is found \"not guilty\"?","volume":"23","author":"Grossi","year":"2017","journal-title":"World J Gastroenterol"},{"key":"2025082700385283000_15.11.e251238.4","article-title":"Herpes simplex virus-2 esophagitis in a young immunocompetent adult","volume":"2016","author":"Kadayakkara","year":"2016","journal-title":"Case Rep Gastrointest Med"},{"key":"2025082700385283000_15.11.e251238.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.02.040"},{"key":"2025082700385283000_15.11.e251238.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.1997.tb00275.x"},{"key":"2025082700385283000_15.11.e251238.7","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e3181e949ed"},{"key":"2025082700385283000_15.11.e251238.8","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1007\/s10620-019-05493-x","article-title":"Variations in the clinical course of patients with herpes simplex virus esophagitis based on immunocompetence and presence of underlying esophageal disease","volume":"64","author":"Hoversten","year":"2019","journal-title":"Dig Dis Sci"},{"key":"2025082700385283000_15.11.e251238.9","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/S0016-5107(91)70862-6","article-title":"Herpes esophagitis: clinical syndrome, endoscopic appearance, and diagnosis in 23 patients","volume":"37","author":"McBane","year":"1991","journal-title":"Gastrointest Endosc"},{"key":"2025082700385283000_15.11.e251238.10","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/0016-5085(94)90613-0","article-title":"Esophageal infections: risk factors, presentation, diagnosis, and treatment","volume":"106","author":"Baehr","year":"1994","journal-title":"Gastroenterology"},{"key":"2025082700385283000_15.11.e251238.11","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1053\/j.gastro.2018.07.009","article-title":"Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the agree conference","volume":"155","author":"Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"2025082700385283000_15.11.e251238.12","doi-asserted-by":"crossref","first-page":"679","DOI":"10.2147\/JAA.S238565","article-title":"The role of food allergy in eosinophilic esophagitis","volume":"13","author":"Wilson","year":"2020","journal-title":"J Asthma Allergy"},{"key":"2025082700385283000_15.11.e251238.13","first-page":"463","article-title":"The role of allergy testing in eosinophilic esophagitis","volume":"14","author":"Anyane-Yeboa","year":"2018","journal-title":"Gastroenterol Hepatol"},{"key":"2025082700385283000_15.11.e251238.14","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.anai.2020.03.020","article-title":"AGA Institute and the joint Task force on allergy-immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis","volume":"124","author":"Hirano","year":"2020","journal-title":"Ann Allergy Asthma Immunol"},{"key":"2025082700385283000_15.11.e251238.15","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/MPG.0000000000001748","article-title":"Herpes simplex virus esophagitis in immunocompetent children: a harbinger of eosinophilic esophagitis?","volume":"66","author":"Fritz","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2025082700385283000_15.11.e251238.16","doi-asserted-by":"crossref","DOI":"10.12659\/AJCR.933565","article-title":"Herpetic esophagitis and eosinophilic esophagitis: a potential association","volume":"22","author":"Quera","year":"2021","journal-title":"Am J Case Rep"},{"key":"2025082700385283000_15.11.e251238.17","article-title":"A patient with eosinophilic esophagitis and herpes simplex esophagitis: a case report and literature review","volume":"2021","author":"Marella","year":"2021","journal-title":"Case Rep Gastrointest Med"},{"key":"2025082700385283000_15.11.e251238.18","doi-asserted-by":"crossref","first-page":"606","DOI":"10.5946\/ce.2019.021","article-title":"A case of eosinophilic esophagitis associated with herpes esophagitis in a pediatric patient","volume":"52","author":"Kim","year":"2019","journal-title":"Clin Endosc"},{"key":"2025082700385283000_15.11.e251238.19","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1159\/000521124","article-title":"Acute herpes simplex esophagitis in an immunocompetent adult with eosinophilic esophagitis","volume":"15","author":"Wichelmann","year":"2021","journal-title":"Case Rep Gastroenterol"},{"key":"2025082700385283000_15.11.e251238.20","doi-asserted-by":"crossref","first-page":"393","DOI":"10.17235\/reed.2017.4616\/2016","article-title":"Eosinophilic esophagitis and herpetic esophagitis: cause or consequence?","volume":"109","author":"Bustamante Robles","year":"2017","journal-title":"Rev Esp Enferm Dig"},{"key":"2025082700385283000_15.11.e251238.21","doi-asserted-by":"crossref","DOI":"10.1097\/MPG.0b013e31824d0660","article-title":"Herpes simplex virus and eosinophilic esophagitis","volume":"56","author":"Sehgal","year":"2013","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2025082700385283000_15.11.e251238.22","doi-asserted-by":"crossref","first-page":"406","DOI":"10.17235\/reed.2019.5903\/2018","article-title":"Eosinophilic esophagitis after an episode of herpetic esophagitis","volume":"111","author":"Alcaide Su\u00e1rez","year":"2019","journal-title":"Rev Esp Enferm Dig"},{"key":"2025082700385283000_15.11.e251238.23","doi-asserted-by":"crossref","first-page":"e38","DOI":"10.1111\/ped.12027","article-title":"Herpes simplex primo-infection in an immunocompetent host with eosinophilic esophagitis","volume":"55","author":"\u017daja Franulovi\u0107","year":"2013","journal-title":"Pediatr Int"},{"key":"2025082700385283000_15.11.e251238.24","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1177\/0009922817730350","article-title":"Herpes esophagitis with concomitant eosinophilic esophagitis in a child: a case report","volume":"57","author":"Cristoforo","year":"2018","journal-title":"Clin Pediatr"},{"key":"2025082700385283000_15.11.e251238.25","first-page":"361","article-title":"Concomitant herpetic and eosinophilic esophagitis--a causality dilemma","volume":"75","author":"Monsanto","year":"2012","journal-title":"Acta Gastroenterol Belg"},{"key":"2025082700385283000_15.11.e251238.26","doi-asserted-by":"crossref","first-page":"165","DOI":"10.14309\/crj.2016.38","article-title":"Acute herpes simplex viral esophagitis occurring in 5 immunocompetent individuals with eosinophilic esophagitis","volume":"3","author":"Zimmermann","year":"2016","journal-title":"ACG Case Rep J"},{"key":"2025082700385283000_15.11.e251238.27","doi-asserted-by":"crossref","first-page":"471","DOI":"10.17235\/reed.2018.5508\/2018","article-title":"A case report: asymptomatic esophageal eosinophilia after herpes simplex esophagitis. controversies in the therapeutic approach","volume":"110","author":"Iriarte Rodr\u00edguez","year":"2018","journal-title":"Rev Esp Enferm Dig"},{"key":"2025082700385283000_15.11.e251238.28","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1038\/ncpgasthep1225","article-title":"A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis","volume":"5","author":"Lindberg","year":"2008","journal-title":"Nat Clin Pract Gastroenterol Hepatol"},{"key":"2025082700385283000_15.11.e251238.29","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31817b5b73"},{"key":"2025082700385283000_15.11.e251238.30","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1053\/j.gastro.2014.02.039","article-title":"An unusual cause of odynophagia in a patient with eosinophilic esophagitis","volume":"147","author":"Machicado","year":"2014","journal-title":"Gastroenterology"},{"key":"2025082700385283000_15.11.e251238.31","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2017.06.065"},{"key":"2025082700385283000_15.11.e251238.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2011.09.022"},{"key":"2025082700385283000_15.11.e251238.33","doi-asserted-by":"crossref","DOI":"10.1016\/j.prp.2021.153477","article-title":"Stat6: a review of a signaling pathway implicated in various diseases with a special emphasis in its usefulness in pathology","volume":"223","author":"Karpathiou","year":"2021","journal-title":"Pathol Res Pract"},{"key":"2025082700385283000_15.11.e251238.34","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1016\/j.cgh.2020.08.020","article-title":"Stat6 variants associate with relapse of eosinophilic esophagitis in patients receiving long-term proton pump inhibitor therapy","volume":"19","author":"Mougey","year":"2021","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-251238","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:39:06Z","timestamp":1756280346000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-251238"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":34,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,11]]},"published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1136\/bcr-2022-251238"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-251238","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]}}}