Dr. Justin DeRosa Rowan School of Osteopathic Medicine/Jefferson University Hospital Stratford, NJ
Justin DeRosa, DO1, Matthew Everwine, DO2, Daniel Bodek, DO2, Hong-Guang Gao, MD3, Jonathan Foster, DO4; 1Rowan School of Osteopathic Medicine/Jefferson University Hospital, Stratford, NJ; 2Rowan University School of Osteopathic Medicine, Stratford, NJ; 3Jefferson University Hospital, Cherry Hill, NJ; 4Rowan School of Osteopathic Medicine/Jefferson University, Stratford, NJ
Introduction: Herpes simplex virus (HSV) is common with a serological prevalence of up to 50% in the United States. Comparable to the general population, HSV in patients with inflammatory bowel disease (IBD) commonly effects mucosal surfaces and skin. HSV colitis is rare and has only been limited to immunocompromised patients, including IBD patients on immunosuppressive therapy. We present a case of HSV colitis in an otherwise immunocompetent patient with no prior history of IBD.
Methods: The patient is a 49 year old male who presented to the emergency department complaining of diarrhea, hematochezia, and abdominal pain that progressed over 8 weeks. He denied a prior issue with hematochezia or diarrhea. A hemoglobin on admission was 10.0 and WBC of 11.8. No prior colonoscopies or family history of GI disease. A CT scan of his abdomen revealed diffuse colonic wall thickening with peri-colonic fat infiltration. Stool studies were negative for infection. A fecal calprotectin was noted to be elevated at 2710. Considering the patient's symptoms and image findings, a colonoscopy was performed. The colonoscopy revealed continuous diffuse ulcerations with spontaneous bleeding noted in the sigmoid and splenic flexure. Biopsies were obtained demonstrating acute infection with HSV along with severe active colitis and ulcerations with poorly defined granulomas. At interdepartmental pathology conference these findings were believed to represent IBD. After the diagnosis, he was placed on acyclovir followed by valacyclovir for a 14-day course. The patient’s symptoms gradually improved, and he was instructed to follow up with gastroenterology as an outpatient for a repeat colonoscopy once HSV resolved for additional biopsies to determine the course of IBD therapy. Discussion: Patients suffering from IBD commonly experience opportunistic infections as a result of immunosuppressive therapy. HSV, being one of them, usually manifests as a reactivation on mucosal surface. The GI tract is frequently affected by HSV among immunocompromised populations, with the esophagus and rectum commonly implicated. Colonic involvement resulting in HSV induced colitis is a rare occurrence, with a literature review finding only 16 reported cases. Five of them involved patients with IBD on corticosteroid therapy. Our patient’s case was peculiar due to the lack of immunosuppression in his history. This is the first case of its kind to discover an underlying principal diagnosis of IBD in a patient presenting with acute HSV colitis.
Colon mucosa with active colitis
Colonoscopy showing active colitis
Disclosures: Justin DeRosa indicated no relevant financial relationships. Matthew Everwine indicated no relevant financial relationships. Daniel Bodek indicated no relevant financial relationships. Hong-Guang Gao indicated no relevant financial relationships. Jonathan Foster indicated no relevant financial relationships.