Black esophagus

Excerpt

A 68-year-old man, with a history of hypertension, type 2 diabetes mellitus, chronic renal failure, ischemic cerebrovascular accident, and congestive heart failure was admitted to the emergency department with hematemesis and syncope. It has been learned that he has taken apixaban for the last 1 week as well as his antihypertensive, antidiabetic, and anti-ischemic drugs. There was no history of the intake of corrosive substances. On presentation, the patient was afebrile, and blood pressure of 119/70, heart rate 115, respiratory rate of 18, and room air oximetry of 98%. Laboratory workup revealed decline in hemoglobin from 15.4 g/dL to 11.5 g/dL after 6 h from admission. Platelets count was 340 × 10³/μL, international normalized ratio was 1.64, and serum creatinine was 1.43 mg/dL. Emergent upper gastrointestinal (GI) endoscopy revealed circumferential, black-colored, and necrotic esophageal mucosa, in the lower esophagus, which stops abruptly at the gastroesophageal junction (Fig. 1a). Biopsies were not taken to avoid bleeding because the patient was already under the anticoagulant treatment.

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