title: A difficult case to swallow: herpes esophagitis after epidural steroid injection.
abstract: Herpes esophagitis due to infection with herpes simplex virus typically occurs in immunocompromised patients such as those with human immunodeficiency virus, malignancy, and those undergoing immunosuppressive therapy. Albeit rare, herpes esophagitis can occur in immunocompetent patients as a primary infection. We present a case of herpes esophagitis after corticosteroid treatment for back pain including epidural steroid injections. Corticosteroids, especially local injections, are a common treatment for chronic back pain, but they are not without risk. Epidural steroid injections can have systemic effects, which may go unrecognized and underappreciated. Although local infections have been reported after administering these injections, systemic immune suppression may allow for unexpected infections such as herpes esophagitis. Given the widespread use of epidural steroid injections, physicians should reevaluate the potential for harm when considering this treatment.
authors.affiliation: 1Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA; and 2Department of Internal Medicine, Division of General Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Kelli
authors.initials: K
authors.lastname: Davis
authors.forename: Adam
authors.initials: A
authors.lastname: Prater
authors.forename: Shelly-Ann
authors.initials: SA
authors.lastname: Fluker
authors.forename: Robin
authors.initials: R
authors.lastname: Klein
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology* / Q000473:pathology; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000209:etiology* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007268:Injections, Epidural; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D014221:Triamcinolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D013256:Steroids; D014221:Triamcinolone; D000212:Acyclovir