Herpes simplex virus esophagitis in immunocompetent children.
OBJECTIVE
To review clinical, laboratory, endoscopic and histologic features, treatment and outcome of immunocompetent children with Herpes simplex virus esophagitis.


METHODS
Retrospective analysis of the medical records of six children (five males) referred to our unit between 1997-2001.


RESULTS
The median age at presentation was 4 years. Fever was present in all, odynophagia/dysphagia in five, retrosternal pain in four, vomiting in three, drooling in two and irritability and drowsiness in one. The median time between the onset of symptoms and the diagnosis was 6.5 days. Endoscopy, performed in all, showed friable mucosa and erosive-ulcerative involvement, with histology showing inflammation and ulcerated esophagitis. Tissue viral culture was performed in five patients and was positive in three, and polymerase chain reaction was positive in two of four tested. Serology was consistent with primary Herpes simplex virus infection in all. All received nasogastric feeding and acyclovir. The outcome was very good.


CONCLUSIONS
This is an uncommon and under-recognized condition in the immunocompetent child. The most common symptoms are sometimes not diagnostic, particularly in very young children. The presence of unusual clinical signs may lead to a difficult and delayed diagnosis. Treatment with acyclovir may have hastened the resolution of symptoms, but a controlled clinical study was not performed.
Rodrigues
Fernanda
F
Hospital Pediátrico de Coimbra, Portugal. fmprodrigues@hotmail.com
Brandão
Nogueira
N
Duque
Vitor
V
Ribeiro
Catarina
C
António
Armando Mendes
AM
D000212:Acyclovir / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004941:Esophagitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D018139:Simplexvirus / Q000302:isolation & purification*; D016896:Treatment Outcome
D000998:Antiviral Agents; D000212:Acyclovir