A 31-year-old HIV-positive woman (CD4 count 75 cells/μL) reports 3 weeks of painful swallowing. Endoscopy reveals multiple raised yellow-white plaques in the oesophagus that scrape off leaving shallow erosions. What is the most appropriate treatment?

• A Valganciclovir
• B Omeprazole twice daily
• C Oral fluconazole ✓
• D Swallowed fluticasone

Explanation

Odynophagia with scrapable yellow-white oesophageal plaques in advanced immunosuppression is Candida oesophagitis, an AIDS-defining condition treated with systemic oral fluconazole. Proton pump inhibitors treat reflux oesophagitis, which causes heartburn without plaque formation. Valganciclovir addresses CMV oesophagitis, which typically presents with large linear ulcers rather than diffuse plaques. Swallowed corticosteroids are the treatment for eosinophilic oesophagitis, seen in allergic patients rather than those with CD4 below 100 cells/μL.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.