A 29-year-old HIV-positive woman (CD4 count 70 cells/μL) reports 2 weeks of painful swallowing and retrosternal discomfort. Oral examination shows removable white plaques. Barium swallow would likely show a shaggy oesophagus. What is the most appropriate next step?
- A Intravenous ganciclovir empirically
- B Upper gastrointestinal endoscopy with biopsy before any treatment
- C Empirical oral fluconazole therapy without endoscopy ✓
- D Oral nystatin suspension for 14 days
Correct answer: C. Empirical oral fluconazole therapy without endoscopy
Explanation
In an advanced HIV patient with odynophagia and visible oral thrush, oesophageal candidiasis can be treated empirically with systemic fluconazole; endoscopy is reserved for patients who fail to respond. Ganciclovir treats cytomegalovirus oesophagitis, which typically occurs at CD4 below 50 with large linear ulcers and no thrush. Nystatin acts topically and is inadequate for oesophageal disease, where tissue invasion requires an absorbed azole.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.