A rapidly fatal case of black esophagus in a patient with multiple co-morbidities

Introduction: Black esophagus, or acute esophageal necrosis (AEN), is a rare and severe condition characterized by diffuse black discoloration of the esophageal mucosa. It predominantly affects males in their seventh decade and is characterized by diffuse circumferential black discoloration of the esophageal mucosa. The literature describes the disease entity as multifactorial in origin, although tissue hypoperfusion is predominantly a common association. A high index of suspicion and timely identification of the disease combined with appropriate interventions, especially in elderly patients with multiple risk factors, is necessary to reduce the rate of adverse outcomes and high mortality rates associated with AEN. Case Report: A 73-year-old male with poorly controlled type 2 diabetes mellitus, hypertension, and Barrett’s esophagus presented with massive hematemesis and hemodynamic instability. An urgent endoscopy revealed diffuse black discoloration of the esophageal mucosa with a polypoidal mass at the gastroesophageal junction. The initial biopsy was non-diagnostic, but a repeat biopsy showed poorly differentiated carcinoma. Despite initial recovery and discharge, the patient returned with acute respiratory failure and died within a week. Conclusion: This case highlights the complex interplay between multiple co-morbidities, including an underlying malignancy and the development of AEN. The case emphasizes the importance of early recognition, prompt intervention, and consistent follow-up care in patients with risk factors for AEN. The challenges in obtaining diagnostic biopsies due to tissue friability suggest potential underdiagnosis of underlying malignancy in AEN cases.