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Old 08-26-2011
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Question HIV patient with esophagitis (UW)

Patient with CD4=40 and esophagitis, oral cavity normal. What's the next step?
(Confused with the correct answer, that's why I'm asking here. I would have proceeded differently than suggested).
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Old 08-26-2011
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most common organism at these cd 4 count is CMV, it usually cause inf as cd 4 count <50, so in this case u go for endoscopy and then biposy the lesion owl eye will be in lesion, treat it....
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Old 08-26-2011
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Did they already give fluconazole in question?

Bcoz any kind of esophagitis in AIDS pt ,you start with fluconazole , if symptom improves continue .
If symptoms are still there then u do endoscopy with biopsy to differentiate HSV and CMV esophagitis , n then treat accordingly.
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Old 08-26-2011
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Quote:
Originally Posted by usmlekzz View Post
Did they already give fluconazole in question?

Bcoz any kind of esophagitis in AIDS pt ,you start with fluconazole , if symptom improves continue .
If symptoms are still there then u do endoscopy with biopsy to differentiate HSV and CMV esophagitis , n then treat accordingly.
I agree. First treat with Fluconazole, if there is not improve, do endoscopy.
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Old 08-26-2011
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They had not given fluconazole yet. And, in fact, the answer was fluconazole. They explained later that first it's a try of fluconazole and, if there's no answer, then do endoscopy and biopsy and so on.
Only, that I also think, that, if there're no oral lesions, I would have gone for endoscopy first, especially with less than 50 CD4 - the chances of it being CMV are very very high.
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Old 08-26-2011
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Quote:
Originally Posted by dr_mhm View Post
They had not given fluconazole yet. And, in fact, the answer was fluconazole. They explained later that first it's a try of fluconazole and, if there's no answer, then do endoscopy and biopsy and so on.
Only, that I also think, that, if there're no oral lesions, I would have gone for endoscopy first, especially with less than 50 CD4 - the chances of it being CMV are very very high.
Whenever you see you symptoms of esophagi ties in aids pt , give fluconazole first bcoz candida is most common cause .....
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