PANCE Gastrointestinal (GI) and Nutrition Practice Test

Candida esophagitis is the likely diagnosis. In immunocompromised patients, especially those with HIV, esophageal involvement by Candida presents with dysphagia and odynophagia, and endoscopy often shows small yellow-white plaques with surrounding erythema. A PAS stain highlighting yeasts (and often pseudohyphae) confirms a fungal organism. This pattern distinguishes it from herpes esophagitis, which typically has vesicular lesions and punched-out ulcers with viral inclusions on biopsy, and CMV esophagitis, which shows large, linear ulcers with owl’s-eye inclusions. Tuberculosis esophagitis is far less common and would raise suspicion for granulomatous inflammation with acid-fast bacilli.