Case History/Examination:
The patient, a 59-year-old female with a history of primary sclerosing
cholangitis, had undergone orthotopic liver transplantation from a CMV
seropositive donor six years prior. She presented with a one-week
history of dysphagia. Her immunosuppression regimen post-transplant
included prednisone, tacrolimus, and mycophenolate. She also had a
history of achalasia secondary to scleroderma, which was treated with
esophageal peroral endoscopic myotomy (EPOEM) one year ago. The
differential diagnosis included infectious agents like CMV, HSV, and
Candida, typical in immunocompromised patients with esophagitis.