Herpes Esophagitis : Treatment
Treatment of Herpes Esophagitis: The infection is self-limited in most immunocompetent hosts. However, upper gastrointestinal bleeding and perforation have been reported in rare cases. Treatment consists of orally-administered 7 to 10-day course of antiviral agent Acyclovir or Valacyclovir. Patients with severe odynophagia may require IV acyclovir initially and then changing to oral therapy when they are able to swallow. This is a high magnification view showing numerous multinucleated squamous cells with Cowdry type A viral inclusions. Note the clumping of chromatin at the nuclear membrane (margination). Some cases of herpes esophagitis are complicated by superimposed bacterial or fungal infection. Herpes may coexist with Candida and/or CMV, especially in immunocompromised hosts.