{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 5, Ep 2 of 2: Infectious and Direct-Injury Esophagitis","html":"","width":"100%","height":180,"duration":1569,"description":"These patients share one principle: the mucosa was injured by something\nthat touched it, whether an organism the host could not keep down, a\ntablet that lodged where the lumen narrows, or a swallowed corrosive.\nDepth reflects contact time, site reflects local anatomy, and host\nstatus reflects who is vulnerable. That framework sorts the differential\nbefore the scope.\n \nThe case. An HIV patient with a CD4 count of 40 has odynophagia and one large,\ndeep, serpiginous distal ulcer on endoscopy. Where do you biopsy, and\nwhat organism are you looking for?\n \nTopics covered\n\nCandida: the most common infectious esophagitis, white adherent plaques\nThe host spine: HIV with CD4 under 200, inhaled steroids, transplant, antibiotics\nHSV: shallow volcano-edge ulcers, epithelial inclusions at the ulcer edge\nCMV: large deep serpiginous ulcers, stromal inclusions at the ulcer base\nThe biopsy-site rule: HSV from the edge, CMV from the base\nTreatment: fluconazole, acyclovir, ganciclovir by organism\nPill esophagitis: kissing ulcers at the aortic arch, offending drugs and technique\nCaustic injury: acid versus alkali, the role and timing of endoscopy\nWhen to biopsy versus treat empirically for Candida\n\n \nKey decisions\n\nHost status sorts the infectious differential before biopsy: Candida with inhaled steroids or CD4 under 200, CMV with CD4 under 50\nBiopsy site is the exam trap: HSV lives in the epithelium at the ulcer edge, CMV in the stroma at the ulcer base\nA classic Candida host with typical plaques can be treated empirically with fluconazole; viral or pill features push to biopsy first\nPill esophagitis is a history diagnosis (a specific tablet taken with little water); stop the drug and coach technique\nCaustic ingestion is graded endoscopically within the first 24 to 48 hours; avoid blind instrumentation of a deeply injured esophagus\n\n \nFor the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com.\nQuestions or feedback: hello@boardpearls.com.","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}