Abstract
This paper describes five renal transplant recipients, out of a series of 221 consecutive patients, who developed herpes simplex esophatitis. This opportunistic infection presented as odyno-and/or dysphagia. It occurred during or shortly after treatment of acute cellular rejection episodes with high doses of steroids and, in four cases, of antilymphocyte globulins. The infection responded to acyclovir in all patients. We conclude from these observations that herpes esophagitis occurs during periods of intensive immunosuppression. Because its endoscopic manifestations are variable, biopsies and cultures are essential to reach the diagnosis. Prevention may be possible by avoiding transplantation from a seropositive donor to a negative recipient and by prophylactic oral acyclovir.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Agha FP, Lee HH, Nostrant TT (1986) Herpetic esophagitis: a diagnostic challenge in immuno-comprised patients. Am J Gastroenterol 81:246–253
Balfour HH, Chace BA, Stapleton JT, Simmons RL, Fryd DS (1989) A randomized, placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Engl J Med 320:1381–1387
Brayko DM, Kozarek RA, Sanowski RA (1982) Type 1 herpes simplex esophagitis with concomitant esophageal moniliosis. J Clin Gastroenterol 4:351–358
Brayman KL, Stephanian E, Matas AJ, Schmidt W, Payne WD, Sutherland DER, Gores PF, Najarian JS, Dunn DL (1992) Analysis of infectious conplications occuring after solid organ transplantation. Arch Surg 127:38–48
Buss DH, Scharj M (1979) Herpes virus infection of the esophagus and other visceral organs in adults. Incidence and clinical significance. Am J Med 66:457–462
Byard RW, Champion MC, Orizaga M (1987) Variability in the clinical presentations and endoscopic findings of herpetic esophagitis. Endoscopy 19:153–155
Cronstedt JL, Bouchama A, Hainau B, Halim M, Khouqeer F, Al Darsouny T (1992) Spontaneous esophageal perforation in herpes simplex esophagitis. Am J Gastroenterol 87:124–127
Depew WT, Prentice RSA, Beck IT, Blakeman JM, Da Costa LA (1977) Herpes simplex ulcerative esophagitis in a healthy subject. Am J Gastroenterol 68:381–385
Deshmuk M, Shah R, McCallum RW (1984) Experience with herpes esophagitis in otherwise healthy patients. Am J Gastroenterol 79:173–176
Desigan G, Schneider RP (1985) Herpes simplex esophagitis in healthy adults. Southwest Med J 78:1135–1137
Dummer JS, Armstrong J, Somers J, Kusne S, Carpenter BJ, Rosenthal JT, Ho M (1987) Transmission of infection with herpes simplex virus by renal transplantation. J Infect Dis 155:202–206
Fishbein PG, Tuthill R, Kressel H (1979) Herpes simplex esophagitis: a case of upper gastrointestinal bleeding. Dig Dis Sci 24:540–544
Johnson HN (1940) Visceral lesions accociated with varicella. Arch Pathol 30:292–307
Kadakia SC (1992) Viral oesophagitis: the endoscopic appearance. Gastrointest Endosc 38:633
Kaye MD (1974) Herpetic conjunctivitis as an unusual occupational hazard (endoscopist's eye). Gastrointest Endosc 21:69–70
Klotz DA, Silverman L (1974) Herpes virus esophagitis, consistent with herpes simplex, visualized endoscopically. Gastrointest Endosc 21:71–73
Koneru B, Tzakis AG, De Puydt, Demetris AJ, Armstrong JA, Dummer J, Starzl TE (1988) Transmission of fatal herpes simplex infection through renal transplantation. Transplantation 45:653–656
McBane RD, Gross JB (1991) Herpes eosophagitis: clincal syndrome, endoscopic apprearence and diagnosis in 23 patients. Gastrointest Endosc 37:600–603
McDonald GB (1989) Esophageal diseases caused by infection, systemic illness, and trauma. In: Sleisenger MH, Fordtran JS (eds) Gastrointestinal disease. Saunders, Philadelphia, pp 840–856
McDonald GB, Sharma P, Hackman RC, Meyers JD, Thomas ED (1985) Esophageal infections in immunosuppressed patients after marrow transplantation. Gastroenterology 88:1111–1117
Nash G, Ross JS (1974) Herpetic esophagitis. A common cause of esophageal ulceration. Hum Pathol 15:339–345
Oh CS, Stratta RJ, Rox B, Sollinger HW, Belzer FO, Matri DG (1988) Increased infections associated with the use of OKT3 for treatment of steroidresistant rejection in renal transplantation. Transplantation 45:68–73
Owensby LC, Stammer JL (1978) Esophagitis associated with herpes simplex infection in an immunocompetent host. Gastroenterology 74:1305–1306
Parente F, Gernuschi M, Rizzardini G, Lazzarin A, Valsecchi, Bianchi-Porro G (1991) Opportunistic infections of the esophagus not responding to oral systemic antifungals in patients with AIDS: their frequency and treatment. Am J Gastroenterol 86:1729–1734
Pearce J, Dagradi A (1943) Acute ulceration of the esophagus with associated intranuclear inclusion bodies. Arch Pathol 35:889–897
Rattner HM, Cooper DJ, Zama MB (1985) Severe bleeding from herpes esophagitis. Am J Gastroenterol 80:523–525
Seale L, Jones CJ, Kathpalia S, Jackson GG, Mozes M, Maddux MS, Packham D (1985) Prevention of herpes virus infections in renal allografts recipients by low-dose oral acyclovir. JAMA 254:3435–3438
Springer DJ, Da Costa LR, Beck IT (1979) A syndrome of acute self-limited ulcerative esophagitis in young adults probably due to herpes simplex virus. Dig Dis Sci 24:535–539
Steinmüller DR, Noviek AC, Steem SB, Graneto D, Swift C (1980) Intravenous immunoglobulin infusions for the prophylaxix of secondary cytomegalovirus infection. Transplantation 49:68–70
Tilney NL, Whittley WD, Diamond JR, Kupiec-Weglinski JW, Adams DH (1991) Chronic rejection—An undefined conundrum. Transplantation 52:389–398
Author information
Authors and Affiliations
About this article
Cite this article
Mosimann, F., Cuénoud, PF., Steinhäuslin, F. et al. Herpes simplex esophagitis after renal transplantation. Transpl Int 7, 79–82 (1994). https://doi.org/10.1007/BF00336466
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00336466