Résumé
Introduction
L’œsophagite aiguë nécrosante est une urgence rare.
Observation
Patiente de 46 ans, diabétique insulinodépendante, qui consultait pour hématémèse, méléna et hématurie macroscopique, associés à des lésions cutanées nécrotiques des membres. L’examen trouvait un bon état hémodynamique, un gigantisme sans acromégalie, des lésions cutanées à type de décollement cutané nécrotique. L’endoscopie montrait un aspect d’« oesophage noir » dont la biopsie présentait une nécrose de la muqueuse et de la sous-muqueuse. La biologie notait une glycémie de 3 g/l, une hyperleucocytose à polynucléaire neutrophile, une hypoascorbémie et une insuffisance gonadotrope hypogonadotrophique et hypothyréotrope. La biopsie des lésions cutanées concluait à une angéite leucoclastique. L’IRM cérébrale objectivait un macroadénome totalement kystisé. Le traitement consistait en une équilibration du diabète, vitaminothérapie, traitement hormonal thyroïdien et une antibiothérapie. Le contrôle endoscopique notait une régression totale de la nécrose oesophagienne. La patiente a présenté au cours de l’hospitalisation une embolie pulmonaire massive qui a causé son décès.
Discussion
L’incidence d’œsophagite aiguë nécrosante est estimée de 0,008 à 0,2 %. Son diagnostic est purement endoscopique (œsophage noir).
Conclusion
À notre connaissance, notre description de cas est la première qui rapporte son association avec un scorbut et un macroadénome hypophysaire.
Abstract
Introduction
Acute necrotising oesophagitis is an uncommon emergency condition.
Case report
A 46-year-old insulin dependent, diabetic woman presented with haematemesis, melaena and macroscopic haematuria, in association with necrotic cutaneous lesions of the limbs. On examination, she was haemodynamically stable, appeared to have giantism without acromegalic features and exhibited bullous skin necrosis. Endoscopy showed the appearances of “black oesophagus” with biopsy revealing mucosal and submucosal necrosis. Blood tests yielded a glucose level of 3 g/l, polymorph leucocytosis, a low ascorbic acid level, hypogonadotrophic hypogonadism and low TSH. Biopsy of the cutaneous lesions demonstrated leucocytoclastic angiopathy. Cerebral MRI showed a completely cystic macroadenoma. Treatment comprised control of her diabetes, vitamin therapy, thyroid hormone replacement and antibiotics. On repeat endoscopy, the oesophageal necrosis had completely disappeared. During her hospital stay, she had a massive fatal pulmonary embolus.
Discussion
The incidence of acute necrotising oesophagitis is thought to be between 0.008% and 0.2%. The diagnosis depends on endoscopy (black oesophagus).
Conclusion
As far as we know, this is the first report of its association with vitamin C deficiency and a pituitary macroadenoma.
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Références
Goldenberg SP, Wain SL, Marignani P. Acute necrotizing esophagitis. Gastroenterology 1990;98:493–6.
Augusto F, Fernandes V, Cremers MI, Oliveira AP, Lobato C, Alves AL, et al. Acute necrotizing esophagitis: a large retrospective case series. Endoscopy 2004;36:411–5.
Gaissert HA, Roper CL, Patterson GA, Grillo HC. Infectious necrotizing esophagitis: outcome after medical and surgical intervention. Ann Thorac Surg 2003;75:342–7.
Wallberg ME, Young P, Finn BC, Thomé M, Chueco AA, Villarejo F. Black esophagus due to acute necrotizing esophagitis. Report of one case. Rev Med Chil 2009;137:672–4.
Trappe R, Pohl H, Forberger A, Schindler R, Reinke P. Acute esophageal necrosis (black esophagus) in the renal transplant recipient: manifestation of primary cytomegalovirus infection. Transpl Infect Dis 2007;9:42–5.
Gurvits GE, Shapsis A, Lau N, Gualtieri N, Robilotti JG. Acute esophageal necrosis: a rare syndrome. J Gastroenterol 2007;42:29–38.
Ben Soussan E, Savoye G, Hochain P, Hervé S, Antonietti M, Lemoine F, et al. Acute esophageal necrosis: a 1-year prospective study. Gastrointest Endosc 2002;56:213–7.
Akkinepally S, Poreddy V, Moreno A. Black esophagus. Cleve Clin J Med 2009;76:400.
Mangan TF, Colley AT, Wytock DH. Antibiotic-associated acute necrotizing esophagitis. Gastroenterology 1990;99:900.
Lacy BE, Toor A, Bensen SP, Rothstein RI, Maheshwari Y. Acute esophageal necrosis: report of two cases and a review of the literature. Gastrointest Endosc 1999;49(4 Pt 1):527–32.
Cattan P, Cuillerier E, Cellier C, Carnot F, Landi B, Dusoleil A, et al. Black esophagus associated with herpes esophagitis. Gastrointest Endosc 1999;49:105–7.
Nagri S, Hwang R, Anand S, Kurz J. Herpes simplex esophagitis presenting as acute necrotizing esophagitis (“black esophagus”) in an immunocompetent patient. Endoscopy. 2007;39(Suppl 1):E169.
Kram M, Gorenstein L, Eisen D, Cohen D. Acute esophageal necrosis associated with gastric volvulus. Gastrointest Endosc 2000;51:610–2.
Mahé A, Kéita S, Blanc L, Bobin P. Esophageal necrosis in the Stevens-Johnson syndrome. J Am Acad Dermatol 1993;29:103–4.
Katsinelos P, Pilpilidis I, Dimiropoulos S, Paroutoglou G, Kamperis E, Tsolkas P, et al. Black esophagus induced by severe vomiting in a healthy young man. Surg Endosc. 2003;17:521.
Haviv YS, Reinus C, Zimmerman J. Black esophagus: a rare complication of shock. Am J Gastroenterol 1996;91:2432–4.
Benoit R, Grobost O. Black esophagus related to acute esophageal necrosis: a new case. Presse Med 1999;28:1509–12.
Katsinelos P, Pilpilidis I, Dimiropoulos S, Paroutoglou G, Kamperis E, Tsolkas P, et al. Black esophagus induce by severe vomiting in a healthy young man. Surg Endosc 2003;17:521.
Tanaka K, Toyoda H, Hamada Y, Aoki M, Kosaka R, Noda T, et al. A relapse case of acute necrotizing esophagitis. Endoscopy 2007;39(Suppl 1):E305.
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Diffaa, A., Samlani, Z., Elanssari, N. et al. À propos d’un nouveau cas d’oesophage noir. Acta Endosc 40, 436–439 (2010). https://doi.org/10.1007/s10190-010-0101-4
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DOI: https://doi.org/10.1007/s10190-010-0101-4