esophagitis in HIV patients! - malik1223

[ArchivalUser]

an HIV patient with CD4 of 40, presenting with substernal chest pain during swallowing, no oral thrush is visible! whats the next step?

1- treat with fluconazole
2- treat with valganciclovir
3- endoscopy

this is not a qbank q, so i dont have an accurate answer for it..
my point is that: do we assume that its a candidal esophagitis and empirically treat with fluconozaole, and if no response, we proceed with endoscopy?

or since the pt CD4 is too low, then we should think of CMV, and do an endoscopy with biopsies, followed by valgan treatment?

thanks everyone

[ArchivalUser]

Exact this kind of q was in uworld...
1st start fluconazole --> if no improvement then Endoscopy to rule out CMV or HSV...

[ArchivalUser]

cool cool... even if the CD4 is that low?

[ArchivalUser]

cna i remember that candidal esophagitis can occur with CD4

[ArchivalUser]

Yeap always start with Fluconazol if you dont see any improvement of the sx in 5 days do endoscopy!!!!!

[ArchivalUser]

cool, thanks
previous post was not complete:
meant to say that candidal esophagitis can occur with CD4 less than 200, while CMV with CD4 less than 50

[ArchivalUser]

Thats true!!! but with a cd4 less than 50 the pt could have any oportunistic infecction + CMV and MAC

[ArchivalUser]

Yeah that's true.We should also kp in mind when answering this kind of question the order in which things are done (afterall that's what this test is all about) and that administration of fluconazole in this case is serving both a diagnostic and therapeutic role.If pt responds to fluconazole regardless of CD4 count then we have a diagnosis if not we proceed to the next best step.