Gurvits Syndrome in the Setting of Diabetic Ketoacidosis: A Case Report and Literature Review

Acute esophageal necrosis (AEN), also known as "black esophagus," is a rare but serious clinical condition characterized by diffuse circumferential necrosis of the esophageal mucosa. It is most commonly associated with states of hemodynamic compromise. Diabetic ketoacidosis (DKA) has been identified as a precipitating factor. We present the case of a 56-year-old female patient with poorly controlled type 2 diabetes mellitus who presented with DKA and melena. Esophagogastroduodenoscopy revealed diffuse circumferential black discoloration of the mid-to-distal esophagus consistent with AEN. Histopathology demonstrated acute inflammation with fungal elements consistent with Candida species. The patient was managed conservatively with intravenous fluids, insulin therapy, proton pump inhibitors, and antifungal treatment, with a favorable clinical outcome. A review of 11 previously reported cases of DKA-associated AEN demonstrates variable clinical presentation but consistently favorable outcomes. This case supports DKA as a precipitating factor for AEN and suggests a potential role of Candida superinfection as a contributing factor in mucosal injury.