Case Presentation: We describe a 59-year-old male patient with a medical history of coronary artery disease, multiple sclerosis, chronic obstructive pulmonary disease, and ischemic stroke. He presented with symptoms including fever, altered mental status, and a rapid heart rate. Initial assessments revealed an elevated white blood cell count, lactic acidosis, acute kidney injury, and signs of pneumonia on a chest CT scan. He was admitted with a diagnosis of septic shock and acute respiratory failure due to pneumonia. The appropriate treatments were administered. Following an episode of vomiting resembling coffee grounds, a bedside upper endoscopy (Figure 1) was performed, revealing findings consistent with acute esophageal necrosis. Intravenous proton pump inhibitor (PPI) treatment was initiated, and the patient showed clinical improvement within three days. However, due to severe disability, poor functional status, and a grim prognosis, the patient requested comfort care.
Discussion: Discussion: AEN is a rare condition that may go unnoticed in some cases. Its most common presentation includes signs of gastric bleeding, such as dark stool and vomiting blood, along with symptoms like upper abdominal tenderness, paleness, and reduced blood flow to the extremities. AEN has been documented in individuals with various acute and chronic medical conditions, including sepsis and type 2 diabetes. Its underlying causes are believed to be twofold: compromised blood circulation and increased metabolic demands due to local tissue damage, leading to tissue death. Typical endoscopic findings involve a widespread darkening of the lower esophagus in a circular pattern, which abruptly stops at the junction between the esophagus and stomach. Treatment options encompass conservative medical management, endoscopic procedures, and surgery in cases of perforation. Physicians should consider AEN as a potential diagnosis in patients with upper gastrointestinal bleeding and multiple underlying health issues, promptly conducting endoscopy to ensure accurate diagnosis and management of this uncommon yet serious condition.
Conclusions: Acute esophageal necrosis (AEN) is a rare medical condition characterized by the death and darkening of the esophageal mucosa in a circular pattern, often accompanied by damage like erosions, ulcers, and shedding of the mucosa. It was first described in 1990, and only a few hundred cases have been documented since then. AEN has a high mortality rate, ranging from 31.8% to 50%, with most deaths linked to underlying illnesses. In this report, we present a case of AEN likely caused by sepsis resulting from pneumonia. This case contributes to our understanding of this uncommon condition, shedding light on its clinical presentation, diagnostic assessment, and management.
