Black Esophagus: A Case of Acute Esophageal Necrosis in a Recovering Alcoholic

Acute esophageal necrosis (AEN), often called black esophagus, is a rare but serious entity characterized by circumferential black discoloration of the esophageal mucosa. It typically presents in debilitated individuals but can also manifest following an acute insult in otherwise healthy patients. We describe a 33‑year‑old man with alcohol dependence who presented with hematemesis and coffee‑ground vomiting after a binge. Urgent endoscopy revealed extensive black necrotic lesions from the mid to distal esophagus. Conservative treatment with IV proton pump inhibitors (PPIs), fluid resuscitation, and supportive care led to gradual mucosal regeneration, confirmed on serial endoscopies. The patient recovered completely with conservative management and remained asymptomatic at the six-month follow-up. Clinicians should consider AEN in patients with upper GI bleeding, especially in the context of alcohol abuse or ischemia. Early diagnosis and prompt management can achieve full recovery.