phuluong2k
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14) An AIDS patient undergoes endoscopy for chronic substernal pain that is exacerbated when he swallows. The studies demonstrate inflammation and superficial ulceration of the distal esophagus. Biopsies taken from the area show inflammation and a few cells, particularly in the endothelium of small blood vessels, with markedly enlarged, smudgy, eosinophilic nuclei. Which of the following is the most likely cause of the patient's esophagitis?
A. Acid reflux
B. Candida
C. Cytomegalovirus
D. Herpes simplex
E. Herpes zoster
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| nisha
lil monkey
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After candidiasis, herpes simplex virus type I is the second most common cause of infectious esophagitis. Herpes esophagitis is most commonly seen in immunocompromised patients with AIDS, an underlying malignancy, or a debilitating illness or in patients who have been treated with radiation, steroids, or chemotherapy. The epithelial cells at the edge of the ulcers are characterized by multinucleation, ground-glass nuclei, and characteristic eosinophilic Cowdry type A inclusion bodies.
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| mani
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i agree, its D
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| ARJ
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enlarged, smudgy, eosinophilic nuclei. is cowdry type A
Hence the answer is D. Herpes simplex
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| ibraheem
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What if the cause is cytomegalovirus ?what is the finding in the biopsy?????
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| phuluong2k
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The correct answer is
C. AIDS and other profoundly immunosuppressed patients are vulnerable to infectious esophagitis. Endoscopy with biopsy is usually used to identify the causative agents, which are typically Candida, Herpes simplex, or cytomegalovirus.
Careful review of the biopsy material is warranted, since these patients may actually be infected by more than one agent.
Cytomegalovirus infection, the distinctive histological finding is the presence of small numbers of cells with markedly enlarged nuclei, which on careful observation may show both cytoplasmic and nuclear viral inclusions. Cytomegalovirus infection can be treated with ganciclovir.
Acid reflux (choice A) could produce inflammation, but would not alter nuclear morphology.
Candida (choice B) would have hyphal and yeast forms.
Herpes simplex (choice D) causes multinucleated cells with nuclear viral inclusions.
Herpes zoster (choice E) infection would resemble herpes simplex infection, but it much less commonly involves the esophagus.
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