An 80-year old woman presented to our institution with severe odynophagia. Gastroendoscopy revealed the
presence of multiple small, oval ulcers, some of them agglutinated, from the oral cavity to the gastro-esophageal junction. Histopathological analysis of a biopsy specimen of the ulcer margin revealed degenerative epithelial cells with intranuclear eosinophilic inclusion bodies and multinucleated epithelial giant cells. Therefore, HSV esophagitis was suspected, and valacyclovir was administered for 6 days. Two days later, the symptoms resolved. Subsequently, the patient was revealed positive for serum HSV-1 IgM and IgG as well as anti-HSV-antibody by immunohistochemical analysis, confirming the diagnosis of HSV esophagitis. Gastroendoscopy performed 10 days after the treatment revealed the total disappearance of the esophageal lesions. The patient was discharged on 22 days after admission.