Review Question - QID 214719

A 60-year-old man with HIV presents with a 3-week history of retrosternal chest pain and pain while swallowing food. He was seen at an urgent care center 3 weeks ago and was treated with fluconazole, but his pain is not improving. He has a history of acne as a teenager which required antibiotics, as well as hypertension and acid reflux. His current medications include lisinopril, lansoprazole, emtricitabine, tenofavir, and efavirenz. He reports taking his HIV medications inconsistently. His father has a history of asthma and seasonal allergies. His temperature is 100.8°F (38.2°C), blood pressure is 130/80 mmHg, pulse is 110/min, and respirations are 16/min. On physical examination, he has marked epigastric tenderness but no other abnormalities. Laboratory examination shows:

Leukocyte count: 6,000/mm^3
CD4+ count: 50/mm^3

An endoscopy is shown in Figure A. Biopsy demonstrates intranuclear and intracytoplasmic inclusions. Which of the following is the most likely diagnosis?