title: Total dysphagia after short course of systemic corticotherapy: herpes simplex virus esophagitis.
abstract: A 72 year-old female developed a herpetic esophagitis after 3 d of oral corticotherapy for an acute exacerbation of chronic obstructive pulmonary disease, presenting as odynophagia and total dysphagia. Biopsies were taken during a first esophagogastroduodenoscopy (EGD) and the patient was referred to the thoracic surgery service with a presumptive diagnosis of esophageal cancer. A second EGD was planned for dilatation, but by that time the stenosis was completely resolved. The biopsies taken during the first EGD revealed multiple herpetic viral inclusions and ulcerations without any dysplasia or neoplasia. In front of a severe esophageal stenosis, one must still exclude the usual differential diagnosis peptic stenosis and cancer. Visualization of endoscopic lesions can suggest the diagnosis but must be promptly confirmed by biopsy, viral culture or polymerase chain reaction. Although immune systemic effects of corticotherapy are well known and herpetic esophagitis occurs most frequently in immunocompromised individuals, this case emphasizes the importance of clinical awareness concerning short courses of corticotherapy for immunocompetent individuals. This article discusses the reactivation process of herpetic infection in this context and addresses its diagnostic and therapeutic issues.
authors: Division of Thoracic Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal H3L 2H8, Canada. isa.jette-cote@mail.mcgill.ca
authors: Isa
authors: I
authors: Jetté-Côté
authors: Denise
authors: D
authors: Ouellette
authors: Claire
authors: C
authors: Béliveau
authors: Andrew
authors: A
authors: Mitchell
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003680:Deglutition Disorders / Q000139:chemically induced* / Q000821:virology; D004334:Drug Administration Schedule; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000139:chemically induced* / Q000821:virology; D005260:Female; D006561:Herpes Simplex / Q000139:chemically induced* / Q000821:virology; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy*; D018139:Simplexvirus / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D000998:Antiviral Agents
keywords: Corticosteroids; Dysphagia; Esophagitis; Herpes simplex; Immunocompetence
references: Saudi J Gastroenterol. 2011 Sep-Oct;17(5):353-6
references: 21912064
references: Autoimmun Rev. 2011 Apr;10(6):305-10
references: 21224015
references: Oral Dis. 2006 May;12(3):254-70
references: 16700734
references: Eur J Dermatol. 2005 Jul-Aug;15(4):293-7
references: 16048763
references: Chest. 2006 Oct;130(4):1203-10
references: 17035457
references: Dis Esophagus. 2005;18(5):340-4
references: 16197537
references: Eur Radiol. 2004 Mar;14 Suppl 3:E84-102
references: 14749950
references: J Oral Pathol Med. 1997 Aug;26(7):305-9
references: 9250929
references: Curr Opin Pharmacol. 2012 Jun;12(3):293-9
references: 22321568
references: Am J Respir Crit Care Med. 2011 Jan 15;183(2):204-14
references: 20709824
references: Arch Virol. 1990;112(1-2):81-101
references: 2164377
references: Medicine (Baltimore). 2010 Jul;89(4):204-210
references: 20616659
references: Intensive Care Med. 1999 Apr;25(4):415-7
references: 10342519