The condition may be preceded by a flu-like syndrome with fever, sore throat, respiratory symptoms and/or myalgias.
Clinical findings in a patient with Herpes simplex esophagitis:
(1) variable presence of herpes labialis or herpetic vesicles in the mouth or pharynx
(2) acute odynophagia
(3) dysphagia for liquids and solids
(4) retrosternal chest pain
(5) heart burn
(6) weight loss if persistent
In severe cases the patient may develop gastrointestinal bleeding or hematemesis.
Endoscopic features:
(1) Lesions tend to be located in the mid and distal esophagus but they can affect the entire length of the esophagus.
(2) Initially vesicles are seen but these usually progress to discrete, circumscribed erosions or ulcers with raised edges or a punched out appearance. Some patients develop plaque-like lesions.
(3) Lesions may be arranged in a linear fashion along the longitudinal axis of the esophagus. Cobblestoning may be present if the lesions become more confluent.
(4) The mucosa may become friable and show an exudates. In severe cases this can progress to mucosal necrosis.
The diagnosis usually requires demonstration of the virus in either viral cultures, in smears, in biopsies or by PCR.
