CYTOMEGALOVIRUS ESOPHAGITIS MIMICKING HERPETIC ESOPHAGITIS IN A NEWLY DIAGNOSED HIV PATIENT: A DIAGNOSTIC CHALLENGE

Background: Cytomegalovirus (CMV) esophagitis is a severe opportunistic infection occurring almost exclusively in profoundly immunocompromised patients with HIV disease and CD4 counts below 100 cells/uL. It represents an AIDS-defining illness and can be life-threatening if not promptly recognized and treated. Its clinical presentation overlaps significantly with herpetic esophagitis, making diagnosis challenging without endoscopic and histopathological confirmation. Case Presentation: We report the case of a 31-year-old woman with newly diagnosed HIV infection (viral load 1,423,000 copies/mL, CD4 count 60 cells/uL) presenting with painful oral and anal ulcerations, epigastric pain, and retrosternal chest pain. Initial intravenous acyclovir therapy (10 mg/kg/8h) led to partial improvement of mucocutaneous lesions but failed to resolve digestive symptoms - a key clinical clue. Upper GI endoscopy revealed a large ulceration (2×3.5 cm) in the upper third of the esophagus. Histopathological examination of esophageal biopsies confirmed CMV esophagitis, demonstrating endothelial cells containing CMV intranuclear inclusions. Fundoscopy was negative for CMV retinitis. CMV plasma viral load could not be performed due to financial constraints. The patient was treated with intravenous ganciclovir 5 mg/kg/12h for 21 days with complete clinical resolution.