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CMV Disease — SCE Infectious Diseases MCQ

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ModerateHIV MedicineCMV DiseaseSCE Infectious Diseases

A 40-year-old man with HIV (CD4 180 cells/µL) presents with dysphagia and odynophagia. Upper GI endoscopy shows multiple well-circumscribed shallow ulcers in the mid-oesophagus. Biopsy shows intranuclear inclusion bodies with an owl-eye appearance. What is the most likely diagnosis and treatment?

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Correct answer: E — CMV oesophagitis; IV Ganciclovir 5 mg/kg BD for 14–21 days

Large well-circumscribed shallow ulcers with intranuclear owl-eye inclusion bodies on biopsy are characteristic of CMV oesophagitis. This occurs in advanced HIV (typically CD4 <100, but can occur at higher counts). IV Ganciclovir 5 mg/kg BD for 14–21 days is the treatment of choice. Oral Valganciclovir 900 mg BD is an alternative if the patient can swallow. HSV oesophagitis characteristically causes small, multiple, shallow ulcers with multinucleated giant cells and Cowdry type A inclusions on biopsy.

Reference: BHIVA 2022 – Opportunistic infection guidelines; BTS 2024 – CMV management