Herpes Simplex Virus esophagitis typically manifests as mucocutaneous lesions in immunocompromised patients, most frequently in organ and bone marrow transplant recipients. However, it has not been appropriately reported as a cause of febrile neutropenia despite being a relatively common opportunistic infection in this patient population. A 58-year-old man recently diagnosed with Ewing Sarcoma for which he was receiving chemotherapy presented with febrile neutropenia. Following a prolonged hospital course characterized by persistent fevers, an endoscopic evaluation was performed and diagnosis of Herpes Simplex Virus esophagitis was confirmed via histopathology. Prompt administration of acyclovir resulted in the complete resolution of the patient's symptoms. Recognition of Herpes Simplex Virus esophagitis as an etiology of febrile neutropenia can ensure more prompt diagnosis and allow for appropriate management of these patients. In addition, this case report emphasizes a need for further research into additional diagnostic markers in the workup of these patients and the incorporation of antiviral therapy in febrile neutropenia algorithms.
