Discussion

Patients with HSV-1 esophagitis usually present with dysphagia, odynophagia and fever. The diagnosis is confirmed via a biopsy or culture ¹. The indication of acyclovir in immunocompetent patients is not well-known nowadays. However, early treatment could be an adequate option in order to shorten recovery times and avoid complications. Esophageal eosinophilia is a histological finding with an underlying cause that should be investigated. It is unusual in viral esophagitis, thus they are considered as separate entities.

Eosinophilic esophagitis (EoE) is the term used when esophageal eosinophilia occurs with clinical symptoms related to esophageal dysfunction. It is important to rule out other pathologies, especially proton-pump-inhibitor responsive esophageal eosinophilia. Once EoE is confirmed, the treatment options include topical corticoids or diet therapy ². Several case reports have described the co-occurrence of EoE and HSV. They may be diagnosed simultaneously or successively, raising a possible causal relationship. It is thought that the entity which appears first produces a mucosal injury that favors the subsequent appearance of the second entity ^3,4,5. Our patient probably first presented with herpetic esophagitis, which was treated. Subsequently, he was asymptomatic and esophageal eosinophilia was identified, the treatment of which is controversial. Therefore, the following questions are proposed: