Herpes simplex virus

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 12 January 2018, last major update October 2012

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

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

Cite this page: Weisenberg, E. Herpes simplex esophagitis. website. Accessed June 19th, 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
  • 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:

Images contributed by Dr. Nilesh Patel, California:

70 year old
man with Candida
and herpes esophagitis

Images 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)