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Herpesviruses I and II, varicella-zoster virus, and CMV can all cause esophagitis; particularly common in immunocompromised pts (e.g., AIDS). Odynophagia, dysphagia, fever, and bleeding are symptoms and signs. Diagnosis is made by endoscopy with biopsy, brush cytology, and culture.
Disease is usually self-limited in the immunocompetent person; viscous lidocaine can relieve pain; in prolonged cases and in immunocompromised hosts, herpes and varicella esophagitis are treated with acyclovir, 400 mg PO five times a day for 14–21 days or valacyclovir 1 g PO tid for 7 days. CMV is treated with ganciclovir, 5 mg/kg IV q12h, until healing occurs, which may take weeks. Oral valganciclovir (900 mg bid) is an effective alternative to parenteral treatment. In nonresponders, foscarnet, 90 mg/kg IV q12h for 21 days, may be effective.