A HIV positive man with CD4 count of 25 presented with complaints of painful swallowing for the past 2 days. He never had similar issues in the past. The patient has been non-compliant with his HAART medications and PCP prophylaxis. The patient also reports that three days ago, he visited the ER for a cold sore on his lip and he was started on Acyclovir orally by the ER physician. On physical examination he is febrile with temperature of 101F. There is no thrush or pharyngeal erythema. You start the patient on emperic therapy with fluconozole and ask him continue acyclovir. However, his symptoms continue to worsen after one week of emperic therapy. A decision is made to perform endoscopy for further diagnosis . Clinically, the most likely etiology of this patient’s odynophagia is :
A) Resistant Esophageal Candidiasis
B) HSV esophagitis
C) Pill induced Esophagitis
D) Gastro esophageal Reflux disease
E) Esophageal cancer
F) CMV esophagitis
f
If pt has oral thrush,treat empirically with Fluconazole for 2 weeks,if symptoms does not improve then endoscopy
Endoscopic Findings for Herpes simplex
->deep ,small multiple leison-Rx-Acyclovir
CMV-Superficial Large Leison
Rx-Ganciclovir
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F
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