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Odynophagia in a Young Adult Male


A 28-year-old man reports pain on swallowing of a week's duration. He is otherwise in good health. Upper endoscopy and tissue biopsy reveal the cause. What do you see?

HSV esophagitis

Figure. Upper endoscopy image (click to enlarge)

A 28-year-old man presents with a 1-week history of odynophagia. He reports being in his usual state of health before the onset of this symptom. He denies fevers, chills, or upper respiratory tract symptoms. His gastrointestinal review of systems is otherwise unremarkable. On examination, he appears uncomfortable when asked to swallow. Results from his oropharyngeal examination are normal. He undergoes upper endoscopy for further evaluation (Figure). Results of biopsies reveal Cowdry inclusion bodies and ground-glass nuclei.  

1. What is the most common cause of infectious esophagitis?

2. From where specifically should esophageal biopsies be taken?

3. What is the preferred treatment for this patient’s condition?

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