Acute Necrotizing Esophagitis (Black Esophagus): A Rare Entity in Long-Term Renal Transplantation

Acute Necrotizing Esophagitis (AEN) is rare and characterized by necrosis mucosa and submucosa in the distal esophagus at the gastroesophageal junction observed by endoscopy (EDG). It typically arises in patients with multiple comorbidities who have the significant systemic disease and immunocompromised. Specific precipitating events are associated with multiple factors as acute blood loss, sepsis, and immunosuppression. We report a 66-year-old woman with a deceased donor renal allograft 8 years early, which developed AEN in the septic shock setting by acute lithiasis cholecystitis. Infection by Cytomegalovirus (CMV), Helicobacter pylori (HP) was discarded. She was on immunosuppression regimen triple therapy. Comorbidities were: diabetic Mellitus type 2, cardiopathy, obesity, renal allograft recipient 8 years ago, and sepsis of urinary origin by Escherichia coli 15 days earlier. EDG showed devitalized and yellowish fibrous mucosa with areas of black dotted with ischemic appearance. Line Z was swollen. Therapy on Intensive Care Unit (ICU) support was a fluid infusion, catecholamine perfusion, antibiotics, and proton pump inhibitors. Recovery was complete. Neither stenosis nor perforation was evidenced in the long term. EDG at discharge showed a complete esophagus recovery. We describe the first case of AEN as a complication in long-term kidney transplant in which immunosuppression likely plays a
substantial role. Proper recognition and early management will result in an improved clinical outcome.