There are several small, sharply demarcated ulcerations seen in the lower esophagus. Grossly, crops of clear vesicles can evolve to chronic ulceration and induration. Microscopically, the squamous epithelial cells exhibit multinucleation and prominent intranuclear inclusions. The inclusions have a mauve 'ground glass' appearance. These findings are characteristic for Herpes simplex virus (HSV) infection. Such an infection is most likely to occur in an immunocompromised patient, such as a person with the acquired immunodeficiency syndrome or a person undergoing cancer chemotherapy. Herpetic esophagitis is second in frequency to candidiasis as a cause for odynophagia in such patients, and dysphagia may also occur. The oral cavity and esophagus may also be involved with ulcerations. Perforation is rare. HSV is more of a nuisance than a life-threatening infection.