title: Seronegative Herpes simplex Associated Esophagogastric Ulcer after Liver Transplantation.
abstract: Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.
authors.affiliation: Department of Surgery, Technical University of Munich, Munich, Germany.
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.forename: Dietrich
authors.initials: D
authors.lastname: Doll
authors.forename: Gregor
authors.initials: G
authors.lastname: Weirich
authors.forename: Maria
authors.initials: M
authors.lastname: Burian
authors.forename: Carolin
authors.initials: C
authors.lastname: Knebel
authors.forename: Stefan
authors.initials: S
authors.lastname: Thorban
authors.forename: Norbert
authors.initials: N
authors.lastname: Hüser