Acute oesophageal necrosis in a young man with cocaine and alcohol abuse

We report a case of acute oesophageal necrosis (AEN) and non-occlusive mesenteric ischaemia in an otherwise healthy 30-year-old man with cocaine and alcohol abuse. Although cocaine might be expected more frequently to cause oesophageal necrosis through sympathomimetic vasoconstriction, this is only the second known case report of AEN in a patient with cocaine abuse. His symptoms at presentation included epigastric abdominal pain, haematemesis and generalised weakness. He developed moderate neutropenia and severe lactic acidosis. Treatment consisted of intravenous proton-pump inhibitors, granulocyte colony stimulating factor, broad-spectrum antibiotics and ultimately exploratory laparotomy after his condition worsened. He died within 24 hours of presentation from a combination of systemic inflammatory response syndrome, acute respiratory distress syndrome and disseminated intravascular coagulation. AEN was discovered postmortem. We conclude that AEN should be suspected in any patient with haematemesis and substance abuse, and discovery of AEN should prompt a thorough evaluation for potentially lethal comorbid conditions.