Herpes Simplex Virus Esophagitis in an Immunocompetent Patient: Navigating Diagnostic Challenges and Achieving Effective Treatment

Herpes simplex virus (HSV) esophagitis is classically associated with immunocompromised states and is rare in immunocompetent patients, making the presentation of HSV esophagitis in an immunocompetent patient challenging to diagnose. We present the case of a 64-year-old immunocompetent male with a history of gastroesophageal reflux disease (GERD) who developed severe HSV esophagitis. The patient presented initially with severe retrosternal burning and inability to tolerate oral intake. Esophagogastroduodenoscopy revealed severe esophagitis, and biopsy confirmed herpes simplex virus infection. He was treated with acyclovir administered intravenously, followed by oral acyclovir therapy, along with proton pump inhibitor treatment, which resulted in rapid clinical improvement. This case highlights the importance of keeping viral etiologies on the differential for refractory esophageal symptoms, even in the absence of a history of immunocompromise, and underscores the role of endoscopy and biopsy in diagnostic evaluation. Early antiviral therapy was effective, demonstrating the need for prompt recognition and intervention for optimal outcomes. Increasing awareness of such cases can improve understanding and management of this uncommon condition.