In this Image in Clinical Medicine from the New England Journal of Medicine, an upper endoscopy reveals multiple “volcano-like” esophageal ulcers in an adult with an acute history of painful swallowing, fever, and sore throat.
The authors describe a previously healthy adult who presented with fever and odynophagia. During an upper endoscopy, clinicians saw multiple discrete, shallow esophageal ulcers with raised edges.
The differential diagnosis for these “volcano-like” ulcers is broad and includes infections such as herpes simplex virus (HSV), cytomegalovirus, and esophageal candidiasis; pill esophagitis; autoimmune conditions like Crohn’s disease; and malignancies. The patient’s prodrome suggested an infection: Indeed, herpes simplex esophagitis (HSE) was confirmed by histopathological and immunohistochemical testing of a biopsy specimen. HSE is generally associated with HSV-1 and is more commonly seen in immunocompromised patients. When HSE is diagnosed …
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The authors describe a previously healthy adult who presented with fever and odynophagia. During an upper endoscopy, clinicians saw multiple discrete, shallow esophageal ulcers with raised edges.
The differential diagnosis for these “volcano-like” ulcers is broad and includes infections such as herpes simplex virus (HSV), cytomegalovirus, and esophageal candidiasis; pill esophagitis; autoimmune conditions like Crohn’s disease; and malignancies. The patient’s prodrome suggested an infection: Indeed, herpes simplex esophagitis (HSE) was confirmed by histopathological and immunohistochemical testing of a biopsy specimen. HSE is generally associated with HSV-1 and is more commonly seen in immunocompromised patients. When HSE is diagnosed …