Esophagus
Esophagitis
Herpes simplex virus

Author: Elliot Weisenberg, M.D.

Revised: 27 June 2018, last major update October 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Herpes simplex[TI] esophagitis[TI]

Cite this page: Weisenberg, E. Herpes simplex esophagitis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/esophagusHSV.html. Accessed September 22nd, 2018.
Definition / general
  • #2 most common cause of infectious esophagitis after Candida
  • Self limited in healthy patients; may cause esophageal perforation or disseminate in immunocompromised patients
  • May have secondary bacterial or fungal infections
  • Must rule out HSV infection as cause of esophageal ulcers, particularly from immunocompromised patients
Epidemiology
Diagnosis
  • Histology, culture, PCR
Case reports
Gross description
  • Shallow vesicles and ulcers; may coalesce into extensive areas of erosion
Gross images

Images hosted on other servers:

Punched out ulcers

Microscopic (histologic) description
  • Ulcers contain necrotic debris and exudate with neutrophils
  • Viral inclusions are present in multinucleated squamous cells at margin of ulcer; inclusions are usually Cowdry type A (dense eosinophilic intranuclear and cytoplasmic) with thickened nuclear membrane and clear halo; also ground glass inclusions that fill the nuclei and nuclear molding; inclusions may be absent in endoscopic biopsy specimens
  • Aggregates of macrophages with convoluted nuclei are adjacent to inflamed epithelium
  • Prominent mononuclear infiltrate (Hum Pathol 1991;22:541)
  • Concurrent infection with CMV may occur; its inclusions are usually found in endothelial and stromal cells
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by
Raul S. Gonzalez, M.D.

Focal viral cytopathic effect

Margination, multinucleation, and molding


Contributed by Dr. Joseph Christopher Castillo,
 Institute of Anatomical Pathology, Arias Stella, Peru

Ground glass nuclei

Cowdry type A inclusions




Contributed by
Mario Prieto, M.D. ,Ph.D.

38 year old woman with esophagus ulcer; florid herpes esophagitis with diagnostic Cowdry A inclusions and multinucleated cells with nuclear molding and ground glass nuclei


 Contributed by
 Dr. Nilesh Patel,
 California

70 year old
immunocompentent
man with Candida
and herpes esophagitis



 Contributed by
 Dr. Mark R. Wick

Erosive herpes esophagitis



Images hosted on other servers:

Ground glass intranuclear inclusions

Multinucleated giant cells

Positive stains
  • CD68 (large cells with convoluted nuclei)