A 38-year-old man comes to the physician for difficulty swallowing and retrosternal pain for the past 4 months. He has trouble swallowing solid foods but not liquids. The retrosternal pain occurs after meals and worsens when the patient lies down. He has already tried over-the-counter antacids, but they have not provided any symptom relief. The patient has been hospitalized several times recently with Pneumocystis jirovecii pneumonia. He has a history of intravenous drug use. His temperature is 37.8 C (100 F). Oropharyngeal examination is remarkable only for poor dentition. Esophagogastroduodenoscopy is performed and reveals esophageal hyperemia and linear ulcerations. Which of the following is the most likely cause of this patient's condition?

Question

A 38-year-old man comes to the physician for difficulty swallowing and retrosternal pain for the past 4 months. He has trouble swallowing solid foods but not liquids. The retrosternal pain occurs after meals and worsens when the patient lies down. He has already tried over-the-counter antacids, but they have not provided any symptom relief. The patient has been hospitalized several times recently with Pneumocystis jirovecii pneumonia.  He has a history of intravenous drug use.  His temperature is 37.8 C (100 F).  Oropharyngeal examination is remarkable only for poor dentition.  Esophagogastroduodenoscopy is performed and reveals esophageal hyperemia and linear ulcerations.  Which of the following is the most likely cause of this patient's condition?

Quizplus · Accepted Answer

Eductional Objective: Infectious esophagitis is common in patients with HIV.  The most common cause is Candida albicans, although cytomegalovirus and herpes simplex virus are also frequently implicated.  Diagnosis is based on endoscopic and microscopic findings.

A 38-Year-Old Man Comes to the Physician for Difficulty Swallowing