“Black Esophagus” or Gurvits Syndrome: A Rare Complication of Diabetic Ketoacidosis

Abstract

Acute esophageal necrosis (AEN) also known as “black esophagus” or necrotizing esophagitis is a rare syndrome characterized by a striking diffuse patchy or circumferential black appearance of the esophageal mucosa that preferentially affects the distal esophagus and terminates at the gastroesophageal junction. Only 88 patients over a span of 40 years have received this diagnosis, and the prevalence of this disease ranges from 0.001 to 0.2% of cases in literature. It more commonly affects men (4 : 1 ratio) in the sixth decade of life. It is associated with a high mortality rate, approaching 32%. We report a case of AEN presenting in the setting of diabetic ketoacidosis (DKA), affecting both the proximal and distal esophagus.

A Dire Presentation of Diabetic Ketoacidosis with "Black Esophagus"

“…"Black esophagus" or necrotizing esophagitis is a rare clinical entity formally recognized in the 1990s, that gained popularity after a series of cases were reported in 2007 [9-10]. It is a life-threatening condition characterized by acute necrosis of the distal esophagus sharply delineated with normal gastric mucosa at the GEJ.…”

Black Esophagus: A Rare Case of Acute Esophageal Necrosis Induced by Diabetic Ketoacidosis in a Young Adult Female

“…Hematemesis occurs in approximately 70% of cases. Other presenting features include vomiting, retrosternal chest discomfort, and dysphagia [1, 6]. Her diarrhea was likely a cofactor in her dehydrated state and may have been operative in the chronicity of her intravascular fluid balance.…”

“…Diabetes and hydrocortisone use may, however, place her in an immunocompromised state and increase the risk of esophageal infection. Nonetheless, her EGD revealed the typical and expected findings of circumferential, diffusely necrotic distal esophageal mucosa terminating abruptly at the gastroesophageal junction and extending proximally [1, 3, 4]. A biopsy was not performed but the usual histological findings in AEN include necrotic material with lymphoplasma cell infiltration, polymorphonuclear neutrophils, and eosinophils [2, 5].…”

“…Acute esophageal necrosis (AEN) is also known as black esophagus or Gurvits Syndrome. It was first described in the medical literature in 1990 by Goldenberg and colleagues but became a distinct clinical syndrome in 2007 by Gurvits [1, 2]. The incidence of the disorder is low and the diagnosis requires a high degree of clinical suspicion and visual inspection on esophagogastroduodenoscopy.…”

Indicaciones poco frecuentes de nutrición parenteral: una revisión de la literatura

“…El tratamiento se basa fundamentalmente en el control de las comorbilidades, la reanimación hídrica, el soporte transfusional, la supresión de ácido con inhibidores de la bomba de protones (IBP) intravenosos (IV), la optimización de la perfusión vascular y el reposo intestinal (8) ; esta entidad se presenta frecuentemente en presencia de caquexia o mal estado nutricional relacionado con condiciones médicas crónicas y patologías oncológicas (9) . La inserción de sondas nasogástricas (SNG) está contraindicada por el riesgo de perforación (8,13) .…”