Herpes esophagitis in otherwise healthy patients: clinical and radiographic findings

The authors report the clinical and radiographic findings in five otherwise healthy male patients with herpes esophagitis who had no underlying immunologic problems. The patients all presented with onset of acute odynophagia after a flulike prodrome of fever, sore throat, or myalgias. In all five patients, double-contrast esophagograms revealed innumerable punctate or linear areas of ulceration, predominantly located in the midesophagus near the level of the left main bronchus. Four patients received viscous lidocaine and antacids, and one patient, intravenously administered acyclovir. All five patients had an acute, self-limited illness with complete resolution of symptoms 10-12 days from the time of presentation. It is concluded that, if the characteristic clinical prodrome is present in patients with typical findings on double-contrast esophagograms, such patients can receive conservative treatment without need for endoscopic intervention.