A case of unusual presentation of acute esophageal necrosis with pneumonia

Abstract

Acute esophageal necrosis (AEN) is a rare and often fatal pathology of unclear etiology affecting the distal two-thirds of the esophagus. Typically, elderly patients with multiple comorbidities present with signs of upper gastrointestinal (GI) hemorrhage. On endoscopy, the mucosa is black due to ischemic necrosis, resulting in the commonly used term "black esophagus." We present a rare case of a 61-year-old male presenting with shortness of breath and hematemesis diagnosed as AEN through endoscopy. This case illustrates the importance of considering AEN as part of differential diagnoses in a rising elderly population with multiple comorbidities that present with upper GI hemorrhage. Treatment should be aimed at maintaining hemodynamic stability with high-dose proton pump inhibitors.

Keywords: Black esophagus; endoscopy; esophageal necrosis; upper gastrointestinal hemorrhage.

Figure 1

Portable chest x-ray: Showing hazy opacification of a portion of the right hemithorax with obliteration of the right hemidiaphragm and fluid extending up the lateral chest wall to almost cap the apex. Left hemidiaphragm is also somewhat hazy suggesting infiltrate and/or fluid

Figure 2

Figure 1 shows the middle third of the esophagus with circumferential necrosis, darkening, and extending to the lower third of the esophagus shown in Figure 2