Gurvits syndrome: a case of acute esophageal necrosis associated with diabetic ketoacidosis

Abstract

Background: Acute esophageal necrosis (AEN), commonly referred to as Gurvits syndrome or "black esophagus", is a rare clinical disease. We present a case of AEN associated with diabetic ketoacidosis (DKA).

Case presentation: A 66-year-old male came to our hospital with coffee-ground emesis, dyspnea, and general malaise. He was treated for type 2 diabetes mellitus using insulin and had not been taking his medication, including insulin, for several days. Laboratory analysis revealed severe hyperglycemia (730 mg/dL), normocytic anemia (hemoglobin level, 7.7 g/dL; mean corpuscular volume, 100.4 fL), high serum potassium (7.6 mEq/L), and a high level of blood urea (98.7 mg/dL). Ketones and glucose were detected in the urine, and serum β-hydroxybutyrate was elevated (2132 µmol/L). Arterial blood gas analysis confirmed metabolic acidosis (pH, 7.29; HCO₃, 10.5 mmol/L). Collectively, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient's condition improved with intravenous fluids, and he received intravenous insulin to treat DKA. According to these findings, the patient was diagnosed with DKA and upper gastrointestinal bleeding. The patient underwent esophagogastroduodenoscopy (EGD) which revealed a circumferential necrosis of the middle and distal esophagus, immediately proximal to the gastroesophageal junction. The patient was then treated with an intravenous proton pump inhibitor. The patient continued to improve with conservative treatment and was subsequently discharged in a stable condition. An EGD repeated 14 days after discharge showed complete healing of the necrotic-like mucosal change without stricture formation of the esophagus.

Conclusions: AEN is rare but potentially life-threatening case of upper gastrointestinal bleeding. Therefore, a clinician should be aware of AEN as a potential cause of upper gastrointestinal bleeding in elderly patients with poorly controlled diabetes and significant comorbidities.

Keywords: Acute esophageal necrosis; Acute necrotizing esophagitis; Black esophagus; Case report; Diabetic ketoacidosis; Gurvits syndrome.

Fig. 1

Esophagogastroduodenoscopy on admission showed a circumferential, diffusely necrotic mucosa necrosis from the middle a to distal portions, b of the esophagus with an abrupt transition at the gastroesophageal junction. c Gastric ulcer on the lesser curvature of the upper body of the stomach with an exposed blood vessel

Fig. 2

Images from a second esophagogastroduodenoscopy performed one day after admission. A circumferential black discoloration of mucosa from the middle (a) to the distal portion of the esophagus (b)

Fig. 3

Esophagogastroduodenoscopy performed 14 days after discharge. A complete healing of the necrotic-appearing mucosal changes from the middle (a) to the distal portion (b) of the esophagus