Candida Esophagitis Causing Acute Esophageal Necrosis: A Case Report

Introduction: Acute esophageal necrosis (AEN) also known as black esophagus is a rare cause of upper gastrointestinal bleeding. It is characterized by circumferential black discoloration of the esophageal mucosa abruptly ending at the gastroesophageal junction. Different mechanisms that are thought to play a role in causation include ischemia, impaired mucosal barrier, and backflow injury from the gastric contents. We present a rare case of acute esophageal necrosis caused by Candida. Case Description/Methods: A 53-year-old gentleman with a history of uncontrolled type 2 diabetes, necrotizingpancreatitis complicated by chronic pancreatitis, alcoholic Child B cirrhosis presented to the emergency with 1 week of nausea, non-bloody and non-bilious vomiting, and diffuse abdominal pain. On admission, the patient was hypotensive to 78/51 mmHg, tachycardic to 106 beats/min, and hypothermic to 34.4 degrees Celsius. Labs were significant for blood glucose of 675 mg/dL, Bicarb 16 mEq/L, Anion gap 26, pH 7.30, BUN 36 mg/dL, Cr 1.4 mg/dL, hemoglobin 8.3 g/dL, WBC 17 k/microL . CT scan of the abdomen revealed gastric distension with fluid-filled distal esophagus. The patient was diagnosed with DKA and admitted to ICU. While getting treated in the ICU, the patient started having coffee-ground emesis. Hemoglobin dropped from 8.3 g/dl to 6.5 g/dl. GI was consulted and emergent upper endoscopy was performed. EGD showed severe esophagitis in the form of diffuse necrotic mucosa, exudates, and black eschars suggestive of AEN. Biopsy showed fungal stain positivity giving a diagnosis of Candida esophagitis. Our patient’s comorbid conditions like diabetes and cirrhosis are some of the many medical conditions that predispose patients to develop AEN. The patient was made NPO and treatment was initiated with IV Pantoprazole and antifungal therapy. The patient responded well to the treatment. Discussion: Acute esophageal necrosis is a disease with high mortality and a high degree of suspicion is required for its diagnosis. Early and aggressive management prevents complications like esophageal perforation which can be fatal. Our patient is an interesting and rare case of AEN caused by Candia esophagitis.Figure 1.: Acute esophageal necrosis.