Endoscopy Challenge #1 - May '09

Upper endoscopy demonstrated severe inflammation of the mid-distal esophagus with linear tracks of vesicular ulcerations and increased friability

Histologic evaluation revealed acute esophagitis with negative immunohistochemistry stain for HSV. Viral culture from esophageal ulcer was positive for HSV type I. In addition, right thumb viral culture also positive for HSV type I. He was treated with IV acyclovir, with significant improvement in symptoms within 24 hours. Workup for HIV was negative