Acute esophageal necrosis in end-stage renal disease.

Acute esophageal necrosis is a rare but often fatal condition characterized by diffuse black discoloration of the esophageal mucosa. While commonly associated with hemodynamic compromise, or infection, the pathogenesis is often multifactorial. We report a fatal case of acute esophageal necrosis in a man in his 50s with untreated long-standing hypertension and newly diagnosed end-stage renal disease. The patient presented with fatigue, loss of appetite, and respiratory distress and was admitted with pneumonia, pulmonary edema, and advanced renal dysfunction. After the initiation of hemodialysis, the patient’s oxygenation status and loss of appetite improved, allowing the resumption of oral intake on day 5. Despite temporary improvement, the patient occasionally complained of chest discomfort. Although we ruled out cardiac disease, diseases of the upper gastrointestinal tract were not considered in the differential diagnosis. On day 10, due to melena and worsening anemia, an urgent upper gastrointestinal endoscopy was performed, revealing acute esophageal necrosis. At that moment, we suddenly realized that the chest discomfort was especially noticeable after meals and caused by acute esophageal necrosis. We continued supportive therapy, but the patient unfortunately passed away. Autopsy revealed acute necrotizing esophagitis with Candida albicans, end-stage renal disease from untreated hypertension, pulmonary edema, and pneumonia. This case provides valuable insight for nephrologists, emphasizing the need to consider this rare but fatal disease in the differential diagnosis of patients presenting with chest discomfort.