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Case Report
A rapidly fatal case of black esophagus in a patient with multiple co-morbidities
1 Resident, Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
2 Resident, Department of Internal Medicine, Saint John’s Episcopal Hospital, Far Rockaway, NY, USA
3 Resident, Department of Pathology, West Virginia University School of Medicine, Morgantown, WV, USA
4 Gastroenterologist, Department of Gastroenterology, University of Tripoli, Tripoli, Libya
Address correspondence to:
Olanrewaju Adeniran
1 Medical Center Drive, Morgantown, WV 26506,
USA
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Article ID: 101495Z01OA2025
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How to cite this article
Adeniran O, Marwizi F, Kirkpatrick J, Adekolu A, Sulaiman A, Cohen EM, Zitun M. A rapidly fatal case of black esophagus in a patient with multiple co-morbidities. Int J Case Rep Images 2025;16(1):33–37.ABSTRACT
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.
Keywords: Acute esophageal necrosis, Barrett’s esophagus, Black esophagus, Esophageal malignancy, Upper gastrointestinal bleeding
SUPPORTING INFORMATION
Acknowledgments
We sincerely thank the clinicians who managed this patient at West Virginia University Hospital.
Author ContributionsOlanrewaju Adeniran - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Farirai Marwizi - Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Joshua Kirkpatrick - Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ayowumi Adekolu - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Abdullahi Sulaiman - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ethan M Cohen - Acquisition of data, Drafting the article, Final approval of the version to be published
Mohamed Zitun - Acquisition of data, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Olanrewaju Adeniran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
