Timeline of clinical course, diagnostic evaluation, and management in an 18-year-old immunocompetent patient with concurrent herpes simplex esophagitis and eosinophilic esophagitis.
Began proton pump inhibitor once daily (planned 8 weeks) and systemic corticosteroids daily for 5 days; symptoms improved. Referred to GI. Medication details: omeprazole 20 mg daily for eight weeks and a five-day course of prednisolone 15 mg/mL daily.
GI evaluation
GI clinic
Persistent or recurrent dysphagia/odynophagia prompting evaluation
Planned EGD
Proceeded to EGD with biopsies.
EGD
Endoscopy suite
Dysphagia/odynophagia with reflux symptoms
EGD: Los Angeles Grade B reflux esophagitis, no bleeding; biopsies obtained
Pathology later showed findings consistent with HSE and EoE.
Pathology result review
Follow-up/results
Review of dual diagnosis
Histopathology consistent with HSV cytopathic effect and esophageal eosinophilia
Antiviral therapy initiated for HSE; plan to address EoE after viral management.Medication details: acyclovir 400 mg five times daily for ten days, followed by omeprazole 20 mg daily.
The abstract was originally presented at the American College of Gastroenterology Conference 2025 in Phoenix, Arizona https://journals.lww.com/ajg/fulltext/2025/10002/s4309_intersecting_pathologies__herpes_simplex.4308.aspx. The abstract, on conference acceptance, was published in the American Journal of Gastroenterology. However, the abstract has since been modified to fit the requirements of this journal. The publication of this manuscript and the data involved in other journals is not affected by the conference organizers.
Author contributions
SS: Conceptualization, Investigation, Writing—original draft, Writing—review & editing, Visualization. BY: Writing—original draft. DS: Writing—review & editing. SCS: Writing—review & editing. TO: Supervision, Validation, Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
There is a familial relation between the authors Sahil Sabharwal, Deepak Sabharwal, and Sarat C. Sabharwal. The authors declare that this relationship did not influence the work, and there are no conflicts of interest. The other authors declare that there are no conflicts of interest.
Ethical approval
This case report was conducted in accordance with the World Medical Association Declaration of Helsinki. Institutional Review Board approval from the University of Arkansas for Medical Sciences was not required for the publication of a single de-identified case report in accordance with institutional policy.
Consent to participate
Informed consent to participate in the study was obtained from all participants.
Consent to publication
Informed consent to publication was obtained from the relevant participant, including consent for publication of any accompanying images.
Availability of data and materials
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