{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T01:57:27Z","timestamp":1783389447430,"version":"3.54.6"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T00:00:00Z","timestamp":1768435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Medicine and Pharmacy Carol Davila"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Acute necrotizing esophagitis (ANE), also known as \u201cblack esophagus,\u201d is a rare but life-threatening condition typically occurring in critically ill patients with profound systemic disturbances. Extreme hyperglycemic crises represent an underrecognized precipitating factor, capable of inducing severe metabolic, inflammatory, and microvascular injury. Case Presentation: We report the case of a 54-year-old male admitted with altered mental status and severe dehydration, in whom initial laboratory evaluation revealed extreme hyperglycemia (serum glucose ~1000 mg\/dL), metabolic acidosis, and early multiorgan dysfunction. During intensive care unit hospitalization, the patient developed anemia and severe thrombocytopenia, followed by evidence of upper gastrointestinal bleeding. Urgent upper gastrointestinal endoscopy demonstrated diffuse circumferential black necrosis of the distal esophageal mucosa with abrupt demarcation at the gastroesophageal junction, consistent with acute necrotizing esophagitis, along with associated erosive hemorrhagic gastritis. Comprehensive laboratory evaluation documented marked inflammatory activation and hematologic instability. Management and Outcome: Treatment consisted of aggressive metabolic correction, strict glycemic control, hemodynamic stabilization, infection management, and supportive gastrointestinal care. Progressive clinical and biological improvement was observed, with resolution of bleeding and partial recovery of hematologic parameters. Conclusions: This case highlights a severe hyperglycemic crisis as a major contributing factor within a multifactorial ischemic and inflammatory cascade leading to acute necrotizing esophagitis.<\/jats:p>","DOI":"10.3390\/life16010134","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T11:13:21Z","timestamp":1768475601000},"page":"134","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["When Hyperglycemia Turns Black: Acute Necrotizing Esophagitis in a Catastrophic Metabolic Crisis: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8818-9539","authenticated-orcid":false,"given":"Corina-Ioana","family":"Anton","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Lupu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Mircea","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"},{"name":"Department of Clinical Psychiatry, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2508-2551","authenticated-orcid":false,"given":"Cristian Sorin","family":"Sima","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"},{"name":"Department of Urology, \u201cProf. Dr. Th. Burghele\u201d Clinical Hospital, 20 Panduri Str., 050659 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1159\/000543815","article-title":"Markers of prognosis for acute esophageal necrosis: A systematic review","volume":"43","author":"Kupferman","year":"2025","journal-title":"Dig. Dis."},{"key":"ref_2","first-page":"e24276","article-title":"Acute Esophageal Necrosis Syndrome (Black Esophagus): A Rare Presentation and Review of the Literature","volume":"14","author":"Trad","year":"2022","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"96","DOI":"10.55729\/2000-9666.1020","article-title":"Acute Esophageal Necrosis: An In-Depth Review of Pathogenesis, Diagnosis, and Management","volume":"12","author":"Sheikh","year":"2022","journal-title":"J. Community Hosp. Intern. Med. 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