Herpes simplex virus esophagitis in an immunodeficient patient with non-small-cell lung cancer following a disseminated herpes zoster infection.

rare. It usually occurs in the setting of im− munodeficiency, for example in patients with malignancy [1], patients on immu− nosuppressive therapy [2], or patients with AIDS [3]. A 62−year−old patient with non−small−cell lung cancer (T3N2M1) presented with a 1−month history of persistent dysphagia and odynophagia. Eight weeks before, he had undergone whole−brain radiation therapy for multiple cerebral metastases. A few days later, the patient developed disseminated herpes zoster, secondary to the immunosuppression caused by the radiation. He received systemic therapy with intravenous aciclovir (10 mg/kg per day) for 14 days, resulting in complete re− covery of the skin lesions. Upper gastrointestinal endoscopy re− vealed numerous, coin−shaped, white pseudomembranous lesions, 1 ± 2 cm in diameter, with a discrete central ulcer in the proximal portion of the esophagus which bled readily (l" Fig. 1). The stom− ach and duodenum were normal. Herpes virus infection was not suspected as the cause of the esophagitis at endoscopy. However, biopsy specimens showed typi− cal herpetic histological changes, includ− ing a ground−glass appearance of the nu− clear chromatin, nuclear inclusions, and multinucleation (l" Fig. 2), and positive immunostaining with specific anti−HSV type 1 antibodies (l" Fig. 3), appearances supporting the diagnosis of herpetic esophagitis. Because inflammatory parameters were not significantly elevated and because the patient showed no signs of systemic herpes virus infection or relapse of herpes zoster, he was not given antiviral chemo− therapy. A repeat endoscopy 2 weeks lat− er showed a marked spontaneous im− provement and the patient’s initial symp− toms had resolved. To date, the HSV esophagitis has not relapsed (after 3 months). Proper endoscopic interpretation is a pre− requisite for the recognition of herpes esophagitis because biopsy and culture results can be negative in the early stages of this condition [4]. However, failure to Herpes simplex virus esophagitis in an immuno− deficient patient with non−small−cell lung cancer following a disseminated herpes zoster infection