Acute Esophageal Necrosis in Alcohol Abuse and Diabetic Ketoacidosis

Abstract

Introduction: Acute esophageal necrosis (AEN) is a rare disorder with approximately 112 cases reported. AEN has a mortality rate of over 30% and most commonly presents with signs of upper GI bleed. AEN is caused by hypoperfusion of the esophagus leading to mucosal damage. Some risk factors include age, male gender, diabetes mellitus, alcohol ingestion and malnutrition. Here we present a case of severe esophageal necrosis in the setting of diabetic ketoacidosis (DKA) and alcohol abuse. A 55-year-old male with poorly controlled diabetes and alcohol abuse presented with chest pain, nausea and vomiting, and severe DKA. He subsequently developed upper GI bleed with melena requiring blood transfusion. Urgent EGD showed large hiatal hernia with severe diffuse LA class D esophagitis with black exudates (Figures), involving the entire esophagus. Patient improved clinically with aggressive PPI and topical therapy. EGD 3 weeks later demonstrated healing of the esophagitis. Our case is an example of classic AEN. Patient’s ongoing alcohol abuse, poorly controlled diabetes, and large hiatal hernia most likely contributed to severity of the disease with involvement of most of the esophagus. Current therapy for AEN includes supportive treatment such as hydration and antacids and management of underlying conditions. In this case, despite the high mortality rates associated with AEN, our patient’s condition resolved within 3 weeks of diagnosis after supportive treatment and management of DKA.Figure 1Figure 2