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Acute oesophageal necrosis in a young man with cocaine and alcohol abuse
  1. Caleb Evans Pineo1,
  2. Thomas Zeitler Pineo2
  1. 1Department of Community and Family Medicine, Duke University, Durham, North Carolina, USA
  2. 2University of Pittsburgh Medical Center Health System, Greenville, Pennsylvania, USA
  1. Correspondence to Dr Caleb Evans Pineo, calebpineo{at}


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.

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  • Contributors CEP is the primary author and guarantor of this case report. He wrote the abstract, introduction and discussion. TZP contributed the narrative of the case report, which was then edited by CEP.

  • Competing interests A potential conflict of interest exists in that both authors of this report are brothers to the patient described in this case. While this relationship may bias us toward potentially overestimating the importance of this case to the medical community, we do not believe that this bias has negatively affected the quality of the report or our review of the relevant literature.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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