American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the first-line treatment for CMV esophagitis?

Valacyclovir
Acyclovir
Ganciclovir
Foscarnet

The correct answer is: Ganciclovir

The first-line treatment for cytomegalovirus (CMV) esophagitis is ganciclovir. This antiviral medication is specifically indicated for the treatment of CMV infections, especially in immunocompromised patients, such as those with HIV/AIDS or individuals who have undergone organ transplantation. Ganciclovir works by inhibiting viral DNA synthesis, effectively reducing the viral load and promoting healing in infected tissues. CMV esophagitis often manifests in patients with compromised immune systems, and timely antiviral treatment is crucial for recovery and prevention of further complications. While other antiviral medications, such as acyclovir or valacyclovir, are effective against herpesviruses, they are not effective specifically against CMV. Foscarnet is an alternative therapy for resistant cases but is not considered first-line due to its higher toxicity and side effects. Thus, ganciclovir is the preferred initial choice in managing CMV esophagitis.