Table of ContentsDefinition / general | Epidemiology | Diagnosis | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains
Cite this page: Weisenberg E. Herpes simplex esophagitis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/esophagusHSV.html. Accessed October 25th, 2021.
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
- Usually an opportunistic infection in immunosuppressed / AIDS patients but also affects young immunocompetent children (J Pediatr Gastroenterol Nutr 2004;39:560)
- Histology, culture, PCR
- Shallow vesicles and ulcers; may coalesce into extensive areas of erosion
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
Raul S. Gonzalez, M.D.
Mario Prieto, M.D., Ph.D.
Dr. Nilesh Patel
Images hosted on other servers:
- CD68 (large cells with convoluted nuclei)