Acute Esophageal Necrosis in a Patient With Septic Shock and Advanced Kidney Disease: A Case Report and Literature Review.

Acute esophageal necrosis (AEN), also known as black esophagus, is an uncommon yet life-threatening condition characterized by diffuse circumferential esophageal necrosis, most commonly associated with states of systemic hypoperfusion. We report a case of a 73-year-old male with multiple comorbidities, who developed AEN in the setting of septic shock, advanced chronic kidney disease with acute deterioration of renal function, and severe electrolyte disturbances. The diagnosis was established by upper gastrointestinal endoscopy, which revealed extensive esophageal necrosis with characteristic endoscopic findings. Despite intensive supportive care and multidisciplinary management, the patient experienced progressive clinical deterioration and ultimately died. This case highlights the synergistic contribution of septic shock, advanced renal dysfunction, severe metabolic abnormalities, and refusal of renal replacement therapy to the development of fulminant AEN. It underscores the importance of maintaining a high index of suspicion for AEN in critically ill patients with gastrointestinal bleeding and multiple comorbidities while providing a contemporary review of its pathophysiology, prognostic factors, and clinical outcomes.