The characteristic features of infectious esophagitis are the acute onset of odynophagia and/or dysphagia in a patient who is immunocompromised. Most patients with candida esophagitis also have oral thrush. The combination of oral thrush and esophageal symptoms has a very high positive predictive value for candida esophagitis. However, thrush is absent in up to 15% of patients with esophageal infection by candida. Patients with HSV esophagitis may have herpes labialis or ulcers of the oropharynx.

What are some less common clinical presentations?
In patients with candida and HSV esophagitis, the infections commonly involve only the esophagus and oropharynx. In contrast, CMV esophagitis often occurs as part of a disseminated CMV infection that can involve the stomach, intestine, and a number of other organs. Consequently, approximately 20% to 40% of patients with CMV esophagitis have associated fever, nausea, vomiting, and abdominal pain, whereas such systemic symptoms are uncommon in patients with candida and HSV esophagitis. Although the CMV infection is often disseminated, oral lesions are not commonly associated with CMV esophagitis.

No clinical feature of infectious esophagitis is sufficiently distinctive to establish the identity of the offending organism reliably. Furthermore, in patients with AIDS, the esophagus frequently is infected simultaneously with multiple pathogens, and an esophageal ulceration initially caused by one microorganism may become secondarily infected by another. The establishment of a specific diagnosis of esophageal infection generally requires esophageal biopsy.