HERPESVIRUS-INFECTION OF THE ESOPHAGUS AND OTHER VISCERAL ORGANS IN ADULTS - INCIDENCE AND CLINICAL SIGNIFICANCE

An autopsy review covering a 10 yr period revealed 56 adult patients with histocytologic evidence of herpesvirus (herpes simplex or varicella-zoster) infection involving nongenital viscera. Review of the clinical records of these patients disclosed that herpesvirus infections were clinically suspected in only 7 of them: 3 patients with cutaneous herpes zoster, 2 patients with herpetic keratitis and 2 patients with gingivostomatitis. Nine additional patients also had ulcerative gingivostomatitis, but this was attributed to either fungal organisms or chemotherapy. Forty patients showed no apparent clinical signs or symptoms of herpetic infection. Visceral involvement was not suspected clinically in any of the 56 patients. The most common underlying disease process afflicting these patients was a malignant neoplasm, usually involving the hematopoietic or lymphoreticular systems, but almost 1/3 had a variety of nonmalignant diseases. The presence of an associated infectious process involving bacterial, fungal or protozoal organisms or additional viral agents, was confirmed by culture studies or autopsy microscopic findings in all but 2 patients. The viscus most commonly involved by herpetic infection was the esophagus. Herpetic esophageal ulcers were found in 50 cases, and in 41 cases no other organs appeared involved. Because esophageal ulcers are usually asymptomatic, antemortem diagnosis is extremely difficult. The data derived from this and previous studies indicate that herpetic ulcers frequently become secondarily infected with bacteria and/or fungi and that the greatest clinical significance of these ulcers is as a site of secondary infection, particularly in patients who underwent immunosuppression (immunosuppressed patients). The advent of effective antiherpesvirus drugs and greater clinical awareness of the disease should serve as a stimulus to establish a clinical diagnosis of visceral herpesvirus infection more frequently.