Faculty Bibliography

Eczema herpeticum (EH), or Kaposi's varicelliform eruption, is a skin infection with herpes simplex type I virus (HSV-1) that occurs in patients with compromised skin integrity, such as atopic dermatitis (AD). Unrecognized, it may be fatal and viremia in pregnancy may lead to fetal demise and miscarriage. We describe a rare case of EH in pregnancy, eczema herpeticum gravidarum (EHG), which is the third published report in the literature to date.

Described by Demetrius Chilaiditi in 1910, this classic type of pseudopneumoperitoneum is characterized by interposition of a bowel loop between the liver and the right diaphragm. This creates an appearance of free air, which can be interpreted as constituting a surgical emergency. However, a close inspection of the X-ray reveals colonic haustral markings in an asymptomatic patient

Acute esophageal necrosis, or black esophagus, is a rare disorder that classically presents with upper gastrointestinal bleeding. Esophagogastroduodenoscopy reveals circumferential black mucosa in the distal esophagus ending at the Z-line that may extend proximally to involve the entire organ. Known risk factors include cardiovascular compromise, ischemia, gastric outlet obstruction, malnutrition, and hypercoagulable status. Biopsy reveals mucosal and submucosal necrosis with local inflammatory cell response. Differential diagnosis includes malignant melanoma, acanthosis nigricans, pseudomelanosis, and melanosis of the esophagus. Overall prognosis is poor, and mortality approaches 30% from the underlying clinical disease

Acute esophageal necrosis (AEN), commonly referred to as 'black esophagus', is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusion, vasculopathy, sepsis, diabetic ketoacidosis, alcohol intoxication, gastric volvulus, traumatic transection of the thoracic aorta, thromboembolic phenomena, and malignancy. Clinical presentation is remarkable for upper gastrointestinal bleeding. Notable symptoms may include epigastric/abdominal pain, vomiting, dysphagia, fever, nausea, and syncope. Associated laboratory findings may reflect anemia and leukocytosis. The hallmark of this syndrome is the development of diffuse circumferential black mucosal discoloration in the distal esophagus that may extend proximally to involve variable length of the organ. Classic 'black esophagus' abruptly stops at the gastroesophageal junction. Biopsy is recommended but not required for the diagnosis. Histologically, necrotic debris, absence of viable squamous epithelium, and necrosis of esophageal mucosa, with possible involvement of submucosa and muscularis propria, are present. Classification of the disease spectrum is best described by a staging system. Treatment is directed at correcting coexisting clinical conditions, restoring hemodynamic stability, nil-per-os restriction, supportive red blood cell transfusion, and intravenous acid suppression with proton pump inhibitors. Complications include perforation with mediastinal infection/abscess, esophageal stricture and stenosis, superinfection, and death. A high mortality of 32% seen in the setting of AEN syndrome is usually related to the underlying medical co-morbidities and diseases