Herpes simplex virus esophagitis-clinical challenges in the elderly.

A 77-year-old woman presented with a 2-week history of malaise, prostration, anorexia, abdominal pain, vomiting and diarrhoea. She had been taking systemic corticosteroids for the past year. During hospitalisation, renal insufficiency, ionic changes and liver function abnormalities were detected and corrected. However, the patient developed total dysphagia. UGE revealed multiple shallow ulcers below the cricopharyngeal level and in the distal oesophagus, with normal-appearing intervening mucosa. Histological examination allowed the diagnosis of herpes simplex virus esophagitis. Treatment with intravenous acyclovir was instituted for 14 days. In the elderly, herpetic esophagitis may present with non-specific complains, such as prostration or anorexia. In the reported case, dysphagia was only detected as a late symptom, addressing the importance of maintaining a high degree of suspicion for the diagnosis of herpes simplex virus esophagitis.

Tuberculous lymphadenitis and syndrome of inappropriate antidiuresis, improbable partners.

A patient with acute respiratory infection and severe hyponatraemia was admitted to our department. The hyponatraemia study was compatible with syndrome of inappropriate antidiuresis (SIAD) and an association with the respiratory problem was initially assumed. The recurrence of hyponatraemia after resolution of the pulmonary infection led to further investigation and to the diagnosis of tuberculous lymphadenitis. After treatment of this condition, discontinuation of SIAD treatment was possible, making this association presumable. We would like to highlight the importance of considering alternative conditions in the approach to SIAD.