Author ORCID Identifier
Aqeel Khanani, ORCID# 0000-0003-4899-510X
Herpes simplex virus (HSV) is prevalent worldwide, with a recent report by the World Health Organization estimating that 3.7 billion individuals under the age of 50 have been infected by the virus. After the initial infection, HSV-1 enters a latent phase with the potential for intermittent reactivation, often secondary to episodes of infection, stress, or immunosuppression. Per current literature review, esophageal involvement in the form of herpes simplex virus esophagitis (HSVE) is more commonly associated with immunocompromised patients, such as transplant recipients and HIV-positive individuals. The patient discussed in this report is a 79-year-old female with a past medical history of COPD managed with a daily prednisone dose of 10mg, as well as inhaled fluticasone-umeclidinium-vilanterol, inhaled ipratropium-albuterol, and oral montelukast. During her acute COPD exacerbation, she was initially treated outpatient with an increase in oral prednisone to 20mg daily. Once admitted, patient went on to receive an additional ten days of intravenous methylprednisolone treatment for this prolonged COPD exacerbation. She subsequently developed severe odynophagia refractory to nystatin oral suspension and fluconazole, as thrush was initially expected. As symptoms worsened an EGD and biopsy were ordered, and the patient was later diagnosed with Herpes simplex virus esophagitis. Ensuing HIV testing was negative. Patient responded rapidly to IV Acyclovir, with resolution of symptoms within 48 hours. This unique case highlights that HSVE can be a potential sequela of prolonged corticosteroid treatment for an acute COPD exacerbation.
Khanani A, Mirhadi K. An Unexpected Case of Herpes Simplex Virus Esophagitis Presenting Amidst Corticosteroid Therapy for an Acute COPD Exacerbation: A Case Report. Advances in Clinical Medical Research and Healthcare Delivery. 2022; 2(3). doi: 10.53785/2769-2779.1119.