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.