Dual infection of the esophagus in an immunocompetent individual

• Author Details:   
• Deshidi Srinu ^*
• Amrutha Guguloth

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Background: Infectious esophagitis is predominantly observed in immunocompromised individuals, with Candida albicans, herpes simplex virus, and cytomegalovirus being the most common pathogens. Dual infection involving both Candida and Herpes simplex is exceedingly rare, especially in immunocompetent individuals.

Case Presentation: 50-year-old male with type 2 diabetes mellitus and coronary artery disease presented with progressive dysphagia, odynophagia, chest pain, and weight loss for 6 months. Endoscopy revealed oesophageal ulcers and whitish mucosal plaques throughout the oesophagus. Initial histopathology confirmed Candida infection, and the patient was treated with fluconazole. Due to persistent symptoms and suspicion of other dual aetiology, a repeat endoscopy and biopsy of oesophageal ulcer was performed, which revealed histological features consistent with HSV esophagitis. Serum HSV IgG was positive, and the patient responded well to intravenous acyclovir.

Conclusion: This case underscores the importance of considering dual infections in patients with esophagitis, even in the absence of overt immunosuppression. Early endoscopic evaluation with repeat biopsies, when clinically indicated, is crucial for accurate diagnosis and appropriate treatment.