doc_clotaire
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A 24 yo HIV positive patient who has AIDS for 3 years presents with painfull swallowing and dysphagia to solids and liquids . He has no previous history of heartburn disease . His CD4 count is 41 / UL and he recently required 3 weeks of antibiotics for Pneumocistic Carinii Pneumonia . Examination of the pharynx reveals no oral trush . Barium Swallow demonstrate multiple nodular filling defects of various sizes that resemble a " cluster of grapes " .
Which of the following is the most likely diagnosis ?
a .- Candida esofagitis
b.- Reflux disease
c.- Barrett's esofagus
d.- Pneumoystic esophagitis
e.- Achalasia
f .- Plummer Vinson Sd
g.- Schatzki ring
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| prathapdoctor
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i think A.
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| DrVirgo
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Why A? "Examination of the pharynx reveals no oral thrush"
I think maybe D because he is HIV + and his CD count is under 50...
Whats the right answer?
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| fox
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Oral thrush is not mandatory to cause esophagitis. Candida is the commonest cause of esophagitis in the immunosuppressed. I go with A.
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| webjeee
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answer.
a or d
please explain
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| Guptashutosh
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i`ll go with A too it candida esophgitis.. follow this link
http://www.doctorfungus.org/mycoses/human/candida...
Candidal esophagitis is usually, but not always, associated with simultaneous OPC (oropharyngeal candidiasis)[1840]. Patients with candidal esophagitis will usually have some, if not all, of the following symptoms: dysphagia (a perception of difficulty with swallowing), odynophagia (pain during swallowing), substernal chest pain that is not clearly related to swallowing, and/or a feeling of obstruction in the chest. Candidal esophagitis has been associated with fever [1545], but this is uncommon. Upon endoscopy (see photos), white exudative lesions similar to those of OPC are seen. They may be small or widely spread and contiguous.
Candidal esophagitis in patients with HIV/AIDS is sometimes said to be the "most frequent invasive candidal disease in patients with AIDS". However, biopsy studies have shown that Candida in the esophagus is never invasive in the true sense of the word [885]. Rather the process is limited to the surface of the esophagus. Candidal esophagitis is, however, a significant disease and was the most common AIDS-defining disease in two cohorts of HIV-infected women [1545]. Candidal esophagitis usually occurs when CD4+ counts are below 100 cell/mm3 [1098], although it can also be seen during the transient immunosuppresion of acute HIV infection [444].
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| CocaCola
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A - candida
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| doc_clotaire
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The answer is A
The moral of the story is whenever an AIDS patient with a low CD4 has esofagitis , whether or not there is oral thrush , Think CANDIDA ALBICANS
Thanks for the explanation Guptashutosh
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