# Herpes simplex virus esophagitis in an immunocompromised patient: case report of an atypical presentation

## TL;DR

A 28-year-old HIV patient with severe immunosuppression was diagnosed with herpetic esophagitis through endoscopy and biopsy, highlighting the need for such diagnostic methods in AIDS patients.

## Contribution

This case report emphasizes the importance of endoscopic biopsy in diagnosing herpetic esophagitis in asymptomatic immunocompromised patients.

## Key findings

- Herpetic esophagitis was diagnosed in an HIV patient without typical esophageal symptoms.
- Upper digestive endoscopy with biopsy was crucial for diagnosis despite negative initial tests.
- The patient was treated with acyclovir and showed improvement.

## Abstract

We present the case of a 28-year-old male with diarrhea, headache, and significant weight loss. He was diagnosed with HIV in the AIDS stage (CD4: 3 cells/μL), Cryptococcus neoformans meningoencephalitis, and multisystemic tuberculosis. Given the persistence of diarrhea and negative coproparasitological studies, endoscopic studies were performed. Upper digestive endoscopy incidentally showed esophageal erosions coated with fibrin and punched-out ulcers; these findings were identified as herpetic esophagitis by histopathological and immunohistochemical analysis. Treatment with intravenous acyclovir was initiated, followed by oral administration for 14 days. This case highlights the importance of considering herpetic esophagitis in immunosuppressed patients, even in the absence of esophageal symptoms, and emphasizes the value of upper digestive endoscopy with biopsy in the comprehensive diagnosis of HIV/AIDS.

Se presenta el caso de un varón de 28 años con diarrea, cefalea y pérdida de peso significativa. Fue diagnosticado con VIH en estadio SIDA (CD4: 3 células/μL), meningoencefalitis por Cryptococcus neoformans y tuberculosis multisistémica. Ante la persistencia de diarrea y estudios coproparasitológicos negativos, se realizaron estudios endoscópicos. La endoscopia digestiva alta mostró incidentalmente erosiones esofágicas recubiertas de fibrina y úlceras en sacabocados, estos hallazgos fueron identificados como esofagitis herpética mediante análisis histopatológico e inmunohistoquímico. Se inició tratamiento con aciclovir por vía intravenosa, seguido de administración oral durante 14 días. Este caso resalta la importancia de considerar la esofagitis herpética en pacientes inmunosuprimidos, incluso en ausencia de síntomas esofágicos, y destaca el valor de la endoscopia digestiva alta con toma de biopsia en el diagnóstico integral del VIH/SIDA.