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Upper GI endoscopy. (A) Well delineated ulcers in the esophagus. (B) Salmon colored mucosal tongue with linear ulceration at the gastro-esophageal junction.
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Upper gastrointestinal endoscopy revealed multiple well-delineated ulcers throughout the esophagus, more in the proximal part (Fig. 1).
(A) Intranuclear and cytoplasmic inclusions characteristic of CMV infection (Hematoxylin&Eosin stain; 40x magnification). (B) Ground glass intranuclear inclusion with multinucleation, nuclear molding, and margination of chromatin characteristic of Herpes simplex infection (Hematoxylin&Eosin stain; 40x magnification). (C) Positive staining for CMV (CMV immunostain; 40x magnification). (D) Positive staining for HSV (HSV immunostain; 40x magnification).
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Light microscopic examination of the esophageal biopsies revealed ulceration and acute inflammation along with characteristic viral cytopathic changes of CMV and HSV in the endothelial and squamous cells, respectively (Fig. 2). Immunohistochemical staining for CMV and HSV highlighted the infected cells confirming the microscopic impression of co-infection (Fig. 2).