15th September 2020

A 44-year old man presents with difficulty swallowing

A 44-year old man presents with difficulty swallowing, which began around a week ago. He says that it is difficult to swallow because of associated pain, and he has not been eating properly as a result, and he is also struggling to drink liquids. He denies any acid reflux, a feeling of a lump in his throat, or food getting stuck. He also denies any recent weight loss, although he has not had a good appetite. He has smoked since the age of 15, and drinks around 20 units a week of alcohol, primarily cider. He is an ex-intravenous drug user, and was diagnosed with HIV five years ago. On examination of his mouth and throat, you note that the upper area of the throat is reddened, and there several white plaques covering the tongue and oral mucosa which can be dislodged with a tongue depressor. 

Which of the following is the most likely cause?

Select the SINGLE most appropriate option from the list below. Select ONE option only.