About a new case of black esophagus

Introduction: Acute necrotising oesophagitis is an uncommon emergency condition. Case report: A 46-year-old insulin dependent, diabetic woman presented with haematemesis, melaena and macroscopic haematuria, in association with necrotic cutaneous lesions of the limbs. On examination, she was haemodynamically stable, appeared to have giantism without acromegalic features and exhibited bullous skin necrosis. Endoscopy showed the appearances of "black oesophagus" with biopsy revealing mucosal and submucosal necrosis. Blood tests yielded a glucose level of 3 g/l, polymorph leucocytosis, a low ascorbic acid level, hypogonadotrophic hypogonadism and low TSH. Biopsy of the cutaneous lesions demonstrated leucocytoclastic angiopathy. Cerebral MRI showed a completely cystic macroadenoma. Treatment comprised control of her diabetes, vitamin therapy, thyroid hormone replacement and antibiotics. On repeat endoscopy, the oesophageal necrosis had completely disappeared. During her hospital stay, she had a massive fatal pulmonary embolus. Discussion: The incidence of acute necrotising oesophagitis is thought to be between 0.008% and 0.2%. The diagnosis depends on endoscopy (black oesophagus). Conclusion: As far as we know, this is the first report of its association with vitamin C deficiency and a pituitary macroadenoma. To cite this journal: Acta Endosc. 40 (2010).