Herpes Simplex Virus Esophagitis in an Immunocompetent Hepatitis B Carier: Report of a Case

免疫機能健全之B型肝炎帶原者產生單純疱疹病毒性食道炎：一病例報告

張家昌(Jia-Jang Chang) ； 陳立偉(Li-Wei Chen) ； 劉競榮(Ching-Jung Liu) ； 嚴卓立(Cho-Li Yen) ； 簡榮南(Rong-Nan Chien)

《臺灣消化醫學雜誌》 28卷2期 (2011/06) Pp. 225-228

https://doi.org/10.6557/GJT.201106_28(2).0005

摘要

單純疱疹病毒食道炎常見於免疫機能不全的病患，如惡性腫瘤，接受免疫抑制劑治療，以及後天免疫機能不全症等，但是在免疫機能完全的患者則極少見。通常患者會出現發燒、胸痛、及吞嚥疼痛的典型症狀。在過去肝疾病患者併發單純疱疹病毒食道炎只有少數病例報告，而且這些病例通常合併某種程度免疫機能不全；這些患者有發生廣泛性單純疱疹感染的危險性，因此建議早期使用有效的抗病毒藥物治療。我們報告一例48歲男性免疫機能完全的B型肝炎帶原者，因吞嚥疼痛症狀接受上消化道內視鏡檢查，發現食道下段有多發性潰瘍，病理組織有多核性巨細胞及核內包容體，証實爲單純疱疹病毒食道炎，在給予Sucralfate懸浮液後症狀緩解，於8週後追蹤內視鏡，單純疱疹病毒食道炎完全癒合，此患者未接受任何抗病毒藥物治療。

關鍵字

單純疱疹病毒性食道炎 ； B型肝炎帶原 ； 免疫機能健全

並列摘要

Herpes simplex esophagitis is common in the immunocompromised hosts including those patients with malignancies, immunotherapy, and acquired immunodeficiency syndrome (AIDS), but rarely in immunocompetent patient. They often presented with triad of fever, chest pain, and odynophagia. Herpes simpex esophagitis had been reported in patients with alcoholic liver disease, but they were associated with severe liver disease with some extent of immunodeficiency. The risk of disseminated herpes simplex virus infection is increased in such patients, and effective anti-viral treatment was suggested. We report a 48 years old man, he is a hepatitis B carrier with otherwise healthy presented with odynophagia. Esophagoscopy revealed multiple punched-out ulcers with white membrane coating at 35 cm from the incisor. Histopathology showed multinucleated giant cells and ”Cowdry type A” intranuclear inclusions. He received oral sucralfate gel only. Follow up esophagoscopy 8 weeks later showed complete resolution of esophageal ulcers.

並列關鍵字

herpetic simplex esophagitis ； Hepatitis B carrier ； immunocompetent