Læknablaðið - 15.03.1999, Page 21

LÆKNABLAÐIÐ 1999; 85
211
Vélindabólga af völdum herpes
simplex veiru í annars
heilbrigðum einstaklingum
Gunnar Gunnarsson' 2,1 Guðrún Baldvinsdóttir2’, Auður Antonsdóttir21, Sverrir Harðarson3’, Hallgrímur
Guðjónsson”
Gunnarsson G, Baldvinsdóttir G, Antonsdóttir A,
Harðarson S, Guðjónsson H
Herpes siinplex esophagitis in iinmunocoinpetent
individuals
Læknablaðið 1999; 85: 211-7
Objective: Infections by herpes simplex viruses
(HSV) are common but esophageal involvement is
relatively rare. It is most frequently diagnosed in
immunocompromized patients. We describe four
healthy, young men with HSV esophagitis and
review the literature on the subject.
Material and methods: The diagnosis of HSV eso-
phagitis was considered likely if three out of four of
our criteria were met but definite if all four were
fulfilled. IgM and IgG against HSV was measured
with two different ELISAs. Viral culture was done in
Vero and A-549 cells. Virus typing was done with
ELISA. Histopathological exam was performed. A
MEDLINE search of HSV esophagitis among other-
wise healthy individuals was performed and the
literature reviewed.
Results: Four young, healthy men were diagnosed
with HSV esophagitis in 1997. Diagnosis was likely
in two cases and definite in two. One patient was ini-
tially suspected of heart disease and another of gall-
bladder disease. All four patients were proven to have
primary infection, were hospitalized, given intra-
venous hydration and treated with acyclovir. A MED-
LINE search revealed 12 other cases of HSV esopha-
gitis in otherwise healthy individuals. Including all 16
cases, the age ranged from 18 to 50 years (mean age
26 years). There were two women and 14 men. The
most frequent symptom was odynophagia (69%).
Eight patients (50%) had fever but only six (37.5%)
Frá "lyflækningadeild, "'rannsóknastofu í veirufræði og
3lrannsóknastofu Háskólans í meinafræði, Landspítalan-
um. Fyrirspurnir, bréfaskipti: Gunnar Gunnarsson, lyflækn-
ingadeild og rannsóknastofu í veirufræði, Landspítalanum,
101 Reykjavík. Netfang: gunnarbg@ rsp.is
Lykilorð: herpes simptex veira, vélindabólga, heilbrigðir
einstaklingar.
had lesions in skin and/or niucosa on examination.
Esophageal ulcers or inflammation were detected in
all patients. The changes were in the distal esophagus
(13/16), in the middle (2/16) or the entire organ
(1/16). HSV-1 was cultured from 10 patients. Viral in-
clusions were seen in esophageal samples from eight
patients. HSV antibodies were measured in 10
patients, six of which were proven to have primary
infection.
Conclusions: HSV esophagitis is rare in otherwise
healthy individuals but probably underdiagnosed.
Most cases are young men. Clues to the diagnosis
such as visible lesions in skin or mucosae are fre-
quently not present. Vigilance and endoscopy with
biopsies and culture is needed for an accurate diag-
nosis.
Key words: herpes simplex virus, esophagitis, immuno-
competent individuals.
Ágrip
Inngangur: Sýkingar af völdum herpes
simplex veiru eru algengar en herpes simplex
vélindabólga er hins vegar tiltölulega sjaldgæf.
Langoftast er hún greind hjá ónæmisbældum
sjúklingum. Við lýsurn fjórum ungum, annars
heilbrigðum karlmönnum sem greindir voru
með herpes simplex vélindabólgu og gerum
grein fyrir rituðu máli um þennan sjúkdóm.
Efniviður og aðferðir: Herpes simplex vél-
indabólga var talin líkleg ef þremur af fjórum
skilmerkjum okkar var fullnægt en ákveðin/ör-
ugg ef öllum fjórum var fullnægt. Mótefni,
IgM og IgG, gegn herpes simplex veiru voru
mæld með tveimur mismunandi ELISA aðferð-
um. Veiruræktun var gerð í Vero og A-549
frumum. Herpes simplex tegund var greind með
ELISA aðferð. Sýni tekin frá vélinda voru skoð-
uð af meinafræðingi. Leit var gerð á MED-
LINE að tilfellum herpes simplex vélindabólgu
sem lýst var í annars heilbrigðum einstakling-
um.
Niðurstöður: Fjórir ungir karlmenn greind-
ust með herpes simplex vélindabólgu árið 1997