A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis

This article considers the case of a 19-year-old white woman who presented with a 6-month history of progressively worsening dysphagia. Eosinophilic esophagitis was diagnosed and a PPI and fluticasone propionate prescribed; fluticasone propionate was tapered, but the PPI maintained. When dysphagia returned, fluticasone propionate was restarted, but rapidly progressive dysphagia with severe chest pain and odynophagia developed. A diagnosis of herpes esophagitis with concurrent eosinophilic esophagitis was made, fluticasone propionate treatment immediately discontinued and fluconazole and valaciclovir prescribed.