India HIV Case Discussion - Case #3 Patient with dysphagia

Case Description:
45 yo male of immunocompromised status on ART admitted with difficulty swallowing x5days

Learning Objectives:
1. Recall the differential diagnosis of dysphasia in HIV infected patients.
2. Recall the differential diagnosis and diagnostic approach to esophageal ulcers in HIV infected patients.
3. Describe the pathogenesis and clinical presentation of CMV disease in HIV infected patients.

1. Which of the following is the most likely diagnosis in an HIV infected patient presenting with dysphagia?

Which of the following is the most likely diagnosis in an HIV infected patient presenting with dysphagia? CMV

HSV

Candida esophagitis

Aphthous ulcer

Tuberculosis

2. Which of the following opportunistic infections is the least likely diagnosis in an HIV-infected patient with a CD4 count >100 cells/cmm?

Which of the following opportunistic infections is the least likely diagnosis in an HIV-infected patient with a CD4 count >100 cells/cmm? CMV esophagitis

Laryngeal tuberculosis

Candida esophagitis

Aphthous ulcer

Immune reconstitution syndrome

3. Which of the following diagnostic procedures is most important in the evaluation of a patient with an esophageal ulcer demonstrating intracellular inclusion bodies consistent with CMV?

Which of the following diagnostic procedures is most important in the evaluation of a patient with an esophageal ulcer demonstrating intracellular inclusion bodies consistent with CMV? CMV plasma viral load

Retinal examination

Liver function tests

Sputum culture for viruses

Immunoflourescent staining of the biopsy specimen for CMV

presented May 21, 2008

1. Which of the following is the most likely diagnosis in an HIV infected patient presenting with dysphagia?

2. Which of the following opportunistic infections is the least likely diagnosis in an HIV-infected patient with a CD4 count >100 cells/cmm?

3. Which of the following diagnostic procedures is most important in the evaluation of a patient with an esophageal ulcer demonstrating intracellular inclusion bodies consistent with CMV?