Black esophagus in forensic autopsies: impressive finding and cause of death?

Black esophagus (BE) is characterized by a discoloration of the esophageal mucosa, commonly arising from acute esophageal necrosis. The underlying pathogenesis of BE is poorly understood though it is frequently associated with comorbidities, such as diabetes mellitus, alcohol abuse, infections. Determining the cause of death in cases involving BE at autopsy can be particularly challenging. The report presents the case of a 45-year-old man with a history of alcohol abuse. Autopsy revealed extensive BE along with bilateral pneumonia. Cause of death was determined to be severe pneumonia in combination with acute esophageal necrosis, against a background of chronic alcohol abuse. This case underscores the importance of a thorough forensic investigation, including anamnestic information, autopsy findings and histopathological examination, in order to accurately establish the cause of death, even in presence of dramatic findings such as BE.