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HSV Oesophagitis — SCE Infectious Diseases MCQ

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ModerateHIV MedicineHSV OesophagitisSCE Infectious Diseases

A 32-year-old woman with HIV (CD4 150) presents with odynophagia and retrosternal chest pain. Endoscopy shows well-circumscribed shallow ulcers with raised yellow edges in the mid-oesophagus. Biopsy shows multinucleated giant cells with ground-glass nuclear inclusions and Cowdry type A inclusions. What is the diagnosis?

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Correct answer: B — HSV oesophagitis

Multiple shallow ulcers with raised edges containing multinucleated giant cells, ground-glass nuclei, and Cowdry type A inclusions (eosinophilic intranuclear inclusions with peripheral clearing) are diagnostic of HSV oesophagitis. This contrasts with CMV oesophagitis, which shows large, deep, well-circumscribed ulcers with owl-eye inclusions in endothelial cells. Treatment is IV Aciclovir 5 mg/kg TDS (or oral Valaciclovir 1 g BD if able to swallow) for 14–21 days.

Reference: BHIVA 2022 – OI guidelines; BSAC 2020 – HSV management