A0236 - Vape-Induced Herpes Simplex Esophagitis in an Immunocompetent Host

Award: Presidential Poster Award

Kevin J. Koch, DO¹, Kevin Patel, DO¹, Priyanka Patel, MD^2
1UH Parma Medical Center, Cleveland, OH; ²MD, Cleveland, OH

Introduction: Herpes Simplex Virus esophagitis is a histopathologic diagnosis almost exclusively present in immunocompromised patients. Typical complaints include retrosternal chest pain or non-specific GERD-like symptoms, however occasionally the disease manifests as severe dysphagia and odynophagia. We present a case of a 28-year-old male with no significant medical history presenting to the emergency department on back-to-back days with retrosternal chest pain and worsening odynophagia. Less than two months ago he had begun vaping on a daily basis, frequently in a group setting and sharing with friends. During the preceding week he noted fevers, lethargy, and odynophagia and was presumed to have strep throat. Subsequent EGD with biopsies revealed HSV esophagitis. IV acyclovir almost immediately resolved his symptoms; the patient was quickly transitioned to oral medication and discharged home. HSV esophagitis in an immunocompetent host is exceedingly rare, and vape-induced esophagitis has also been sparingly reported in literature in recent years. Both infectious and non-infectious etiologies for esophagitis should be considered in appropriate populations, and while guidelines for infectious esophagitis in immunocompetent hosts are lacking, we propose initiating antiviral therapy for such patients.

Case Description/Methods: Our case presentation involves a young, immunocompetent man presenting for evaluation of severe dysphagia and odynophagia. Upon further evaluation the patient was found to have HSV esophagitis requiring IV antiviral therapy. Notably, the patient had recently begun using a vape, or nicotine, pen with his friends, and we theorize that he had contracted HSV from these recreational activities. HSV esophagitis is exceedingly rare in immunocompetent hosts and, as such, is worthy of discussion and recognition in this rare case.

Discussion: A link between esophageal damage and vaping has been described briefly in literature, and with the massive influx in vape-users on a daily basis in the USA and across the world, more research and knowledge is needed about both short-term and long-term effects of using such products. This case effectively illustrates the dangers of both vaping on the mucosa barriers of the GI tract as well as the transmission of HSV among vape-sharers. As vaping continues to rise as a social activity, we are confident this will not be the last case reported with such a relationship.



Disclosures:


Kevin J. Koch, DO¹, Kevin Patel, DO¹, Priyanka Patel, MD². A0236 - Vape-Induced Herpes Simplex Esophagitis in an Immunocompetent Host, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.