Korean J Gastroenterol.  2013 Nov;62(5):292-295. 10.4166/kjg.2013.62.5.292.

Herpes Simplex Virus Duodenitis Accompanying Crohn's Disease

• Lee BH
• Um WH
• Jeon SR
• Kim HG
• Lee TH
• Kim WJ
• Kim JO
• Jin SY

• KMID: 1775737
• DOI: http://doi.org/10.4166/kjg.2013.62.5.292

Abstract

Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastrointestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.

Keyword

Crohn disease; Herpes simplex virus; Duodenitis

MeSH Terms

Acyclovir/therapeutic use
Aged
Antiviral Agents/therapeutic use
Crohn Disease/complications/*diagnosis/virology
DNA, Viral/analysis
Duodenitis/complications/*diagnosis
Endoscopy, Digestive System
Female
Herpes Simplex/*diagnosis/drug therapy/virology
Humans
Intestinal Mucosa/pathology
Polymerase Chain Reaction
Simplexvirus/genetics/*isolation & purification
Antiviral Agents
DNA, Viral
Acyclovir

Figure

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  Fig. 1. Esophagogastroduodenoscopic findings of duodenum. They showed (A) diffuse edematous and whitish mucosa with multiple erosions initially, and (B) nearly complete resolution of the diffuse mucosal lesions after viral treatment.

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  Fig. 2. Pathologic findings of the duodenal mucosa. There was blunting of the villi, mononuclear cell infiltration, and mild fibrosis (H&E,×100).

Reference

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