Black Esophagus in a Critically Ill Patient With Septic Shock: A Case Report of a Rare Entity

Acute esophageal necrosis (AEN), also known as "black esophagus," is a rare and severe form of esophageal injury characterized by circumferential black discoloration of the distal esophageal mucosa with a sharp demarcation at the gastroesophageal junction. It commonly presents in critically ill patients with upper gastrointestinal (GI) bleeding, hemodynamic instability, and multiple comorbidities. We present a case of a 65-year-old male with septic shock and multiorgan dysfunction, who was confirmed to have AEN and acute duodenitis on endoscopy and biopsy. The patient was managed conservatively with supportive care, including hemodynamic stabilization, proton pump inhibitors (PPIs), broad-spectrum antibiotics, total parenteral nutrition, and dialysis. Over time, his condition improved, and he was discharged in stable condition. This report emphasizes the need for clinicians to keep AEN in mind when encountering critically ill patients with hemodynamic instability to facilitate prompt diagnosis and effective treatment.