Esophagitis due to CMV most commonly presents with which endoscopic finding?

• A. White-yellow plaques
• B. Orange/gastric epithelium
• C. Invasive dilated veins
• D. Multiple erosions / small ulcers

Answer: (D)

In CMV esophagitis, the endoscopic hallmark is a small number of large, linear ulcers in the distal esophagus, with the surrounding mucosa often relatively unaffected. This pattern reflects CMV’s tendency to cause focal, long ulcers by infecting endothelial cells, rather than widespread mucosal damage. By contrast, white-yellow plaques point to candidal esophagitis, invasive dilated veins describe esophageal varices from portal hypertension, and multiple small ulcers with vesicular appearance are more typical of herpes simplex virus esophagitis. So the endoscopic finding most characteristic of CMV is large, linear ulcers in the distal esophagus.