A Rare Cause of Dysphagia in a Pregnant Woman:Herpes Simplex Esophagitis
A healthy 36-year-old (gravida 3, para 3) female presented to the Infectious Diseases Department at 27 weeks gestation with a six day history of fever, epigastric pain and dysphagia. She had difficulty swallowing liquids, solids, and her own saliva. There was no history of medication use or corrosive ingestion. Her temperature was 38.5°C; other vital signs were normal. Physical examination revealed gingivostomatitis, ulcerations and erythema of the gingiva, buccal mucosa and tongue. Laboratory analyses showed a white blood cell count of 15000/mm3 with 73% neutrophils. Her C-reactive protein was 78 mg/dL. The liver function was normal and HIV serology was negative. Upper endoscopy revealed several white patches and exudates throughout the esophagus with an edematous friable mucosa suggestive of severe candidal esophagitis. Except for mild gastric mucosal erythema, the endoscopy was otherwise normal. Histological examination of the esophageal biopsies revealed multinucleated giant cells with intranuclear inclusion bodies, typical for HSE (). No genital lesions were seen during gynecological examination. Her symptoms resolved completely within five days following the administration of intravenous hydration and a high dose proton-pump inhibitor. She did not receive any antiviral medications. One month later, the patient had no difficulty with swallowing. An esophagogastroduodenoscopy showed a complete resolution of the lesions. At 41 weeks gestation she delivered a healthy daughter that weighed 3100 g, whose Apgar scores were 9 (one minute) and 10 (five minutes). After 14 months of follow-up, the patient and her baby remained in good health.