P3673 - Herpes Esophagitis Triggered by Low Dose Steroids During the Initial Induction Therapy for New Onset Ulcerative Colitis

Raymond Lam, DO¹, Daniel K. Kim, DO², Ningxin Zeng, MD, PhD^2
1Trios Health Southridge Hosptal, Kennewick, WA; ²Trios Health Southridge Hospital, Kennewick, WA

Introduction: Herpes esophagitis caused by the HSV-1 is more commonly seen in immunocompromised individuals but can also occur in immunocompetent patients, although it is relatively rare. Cases were reported in Ulcerative Colitis patients with long-term immunosuppression or high-dose steroids, who are more susceptible to HSV-1 and HSV-2. Here, we report a case of endoscopic witnessing of new-onset herpes infection during ulcerative colitis induction therapy with low dose steroids in an immunocompetent patient.

Case Description/Methods: A 28-year-old male with no major previous medical problems presented with 3 to 4 weeks of bloody diarrhea. He reported having more than 10 bowel movements per day with 30lb weight loss and iron deficiency anemia. Colonoscopy revealed pancolitis with deep ulcers and pathology supported Ulcerative Colitis. Initial EGD showed non-specific gastritis, but no esophagitis. He was started on IV solumedrol 30mg q6hours. Despite improved bloody diarrhea, he developed odynophagia within two days of IV steroid usage. Protonix failed to alleviate the symptoms, prompting a repeat EGD that confirmed the presence of HSV1 and HSV2 through biopsy. HSV was treated with valacyclovir, and his dysphagia improved. Further workup did not show any immunocompromised conditions of disease including HIV, immunoglobulin deficiency, and etc. However, he admitted to have multiple sexual partners with unsafe sexual behavior.

Discussion: Ulcerative colitis and Crohn’s disease with HSV and CMV infection are previously well reported, but are usually seen in double immunosuppressive agents, prolonged treatment or high doses of steroids. Our case reported here, the HSV esophagitis was triggered by a single steroids in low dose and short period during the induction therapy. No evidence of superinfection of colitis suggested that he may have had latent HSV in esophagus with his background of multiple sexual partners with unsafe sexual behavior. In summary, low dose steroids can also trigger Herpes infection in immunocompetent UC patients. It is very important to obtain additional medical history or risk stratification and initiate an early Endoscopy with biopsy to make a diagnosis, then to start antiviral treatment earlier.


Disclosures:


Raymond Lam, DO¹, Daniel K. Kim, DO², Ningxin Zeng, MD, PhD². P3673 - Herpes Esophagitis Triggered by Low Dose Steroids During the Initial Induction Therapy for New Onset Ulcerative Colitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.