Eosinophilic Esophagitis in a Pediatric Patient with Herpes Simplex Virus Esophagitis . A Cause or a Consequence ?

Introduction: Eosinophilic esophagitis is an in lammatory condition that has a variable presentation, but usually upper gastrointestinal symptoms. This condition can usually lead to long term esophageal sequelae. Case: A previously healthy 12year old male, presented with a several day history of abdominal pain, vomiting and fever. An esophagogastroduodenoscopy (EGD) was done and herpes simplex esophagitis (HSVE) was diagnosed. He was treated with acyclovir and a proton pump inhibitor and rapidly improved. A HSVE diagnosis prompted an immunology workup, which noted several decreased lymphocyte proliferation responses. He presented again 9 weeks after discharge with worsening abdominal pain and upper gastrointestinal symptoms. A repeat EGD was done and revealed moderate to severe eosinophilic esophagitis (EOE) and no signs of HSVE. Food allergy testing was completed but was negative. Repeat immunologic testing noted minor T and B lymphocyte abnormalities. He was treated for 3 months with high dose omeprazole and repeat EGD continued to show eosinophilic esophagitis. He was then started on swallowed and inhaled steroids with clinical and histological improvement of his EOE. Conclusion: Our patient noted to subsequently developing EOE after HSVE. EOE needs to be considered in patients presenting with upper gastrointestinal symptoms following HSVE.