Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9571-9576
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9571
Acute esophageal necrosis as a complication of diabetic ketoacidosis: A case report
Kasey Moss, Tahrin Mahmood, Robert Spaziani
Kasey Moss, Department of Internal Medicine, McMaster University, Hamilton L8S 4L8, Ontario, Canada
Tahrin Mahmood, Robert Spaziani, Division of Gastroenterology, McMaster University, Hamilton L8S 4L8, Ontario, Canada
Author contributions: Moss K was the primary author who wrote and revised the paper; Mahmood T contributed to the writing and revising process heavily; Spaziani R provided his expertise and assistance in editing the paper and was the primary physician involved in the patient encounter; all authors have read and approve the final manuscript.
Informed consent statement: The patient whom the case report was written about provided verbal consent to have their case written and submitted for publication prior to the commencement of the case report being written.
Conflict-of-interest statement: None of the authors has any conflicts of interest.
CARE Checklist (2016) statement: The authors have submitted and followed the guidelines within the CARE checklist (2016) statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert Spaziani, FRCP (C), Attending Doctor, Department of Internal Medicine, Division of Gastroenterology, McMaster University, 1280 Main Street West, Hamilton L8S 4L8, Ontario, Canada. spaziar@mcmaster.ca
Received: March 27, 2021
Peer-review started: March 27, 2021
First decision: June 3, 2021
Revised: June 18, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 6, 2021
Abstract
BACKGROUND

Acute esophageal necrosis (AEN) is a rare condition that has been associated with low volume states, microvascular disease, gastrointestinal (GI) mucosal damage, and impaired GI motility. It has been linked in case reports with diabetic ketoacidosis (DKA) and is commonly associated with GI bleeding (GIB).

CASE SUMMARY

We report a case of endoscopy confirmed AEN as a complication of DKA in a 63-year-old Caucasian male without any overt GIB and a chief complaint of epigastric pain. Interestingly, there was no apparent trigger for DKA other than a newly started ketogenic diet two days prior to symptom onset. A possible potentiating factor for AEN beyond DKA is the recent start of a Glucagon-like peptide-1 receptor agonist (GLP-1 RA), though they have not been previously connected to DKA or AEN. The patient was subsequently treated with high dose proton pump inhibitors, GLP-1 RA was discontinued, and an insulin regimen was instituted. The patient’s symptoms improved over the course of several weeks following discharge and repeat endoscopy showed well healing esophageal mucosa.

CONCLUSION

This report highlights AEN in the absence of overt GIB, emphasizing the importance of early consideration of EGD.

Keywords: Acute esophageal necrosis, Gurvits syndrome, Acute necrotizing esophagitis, Black Esophagus, Diabetic Ketoacidosis, Glucagon-like peptide-1 receptor agonists

Core Tip: Acute esophageal necrosis (AEN) is a rare condition with a mortality rate greater than 30%. It has been linked to low volume states including diabetic ketoacidosis in case reports but is usually associated with overt gastrointestinal bleeding (GIB). This report provides an important description of a patient presenting with AEN and no overt GIB. Interestingly, the apparent trigger for ketoacidosis appears to be a ketogenic diet. The case explores Glucagon-like peptide-1 receptor agonists as a possible AEN precipitant, which is not a finding previously described in the existing literature.