Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of severe odynophagia and retrosternal chest pain. Associated symptoms include dysphagia, nausea, and occasional hematemesis. History significant for immunocompromised state (e.g., HIV/AIDS, post-transplant, or chronic corticosteroid use). No history of recent caustic ingestion or pill esophagitis.
Clinical Examination Findings
General: Patient appears in distress due to pain. HEENT: Oral cavity examination reveals presence of herpetic vesicles or ulcers on the lips or oropharynx. Abdomen: Soft, non-tender, no guarding or rebound tenderness. Vital signs: Stable, though tachycardia may be present secondary to pain.
Treatment Protocol
Initiate antiviral therapy: Acyclovir 400 mg PO five times daily or 5 mg/kg IV every 8 hours for 14-21 days. In cases of acyclovir resistance, consider Foscarnet. Provide supportive care with viscous lidocaine for pain management, proton pump inhibitors (PPIs) to reduce acid reflux, and nutritional support as needed. Monitor renal function closely during IV therapy.