HSV infection of visceral organs usually results from viremia; multiple-organ involvement is common, but occasionally only the esophagus, lung, or liver is affected.

• In HSV esophagitis, pts present with odynophagia, dysphagia, substernal pain, weight loss, and multiple oval ulcerations on an erythematous base. Detection of HSV is necessary to distinguish this entity from esophagitis of other etiologies (e.g., Candida esophagitis).
• HSV pneumonitis is rare except among severely immunocompromised pts and results in focal necrotizing pneumonitis with a mortality rate of >80%.
• Hepatic HSV infection occurs primarily in immunocompromised pts and is associated with fever, abrupt elevations of bilirubin and serum aminotransferase levels, and leukopenia (<4000 WBCs/µL).