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HSV Oesophagitis — RACP Adult Medicine MCQ

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HardInfectious DiseasesHSV OesophagitisRACP Adult Medicine

A 40-year-old woman presents with dysphagia and odynophagia. She is HIV positive with a CD4 count of 80 cells/µL. Endoscopy shows large, shallow, well-circumscribed oesophageal ulcers. Biopsies show intranuclear inclusion bodies (Cowdry type A) in squamous epithelial cells. What is the causative organism?

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Correct answer: E — Herpes simplex virus

Large, well-circumscribed, shallow oesophageal ulcers with Cowdry type A intranuclear inclusions (eosinophilic with peripheral clearing) are characteristic of HSV oesophagitis. CMV ulcers tend to be deep and linear with basophilic intranuclear inclusions (owl's eye) and cytoplasmic inclusions. Candida causes adherent white plaques without ulceration. Treatment of HSV oesophagitis is IV aciclovir (if severe) or oral valaciclovir.

Reference: eTG – 2025 – Antibiotic Guidelines; IDSA – 2024 – OI Guidelines in HIV