A 75-year-old male patient with a history of hypertension was admitted to the Intensive Care Unit with a diagnosis of shock.
The patient developed vomiting and heartburn 24 hours before admission.
The family reported an episode of fever and chills.
A nasogastric tube aspiration of coffee grounds was placed.
The patient did not report vomiting or melena.
The patient was resuscitated with crystalloid infusion and required vasopressive drugs during the first 24 h (noradrenaline 0.1 mcg/kg/min).
On admission, hemocultives and urolithiasis were performed, both were positive at 48 h for multisensitive Escherí coli.
Empirical treatment was initiated with ceftriaxone 1 gr every 12 h, which was then changed according to sensitivity and followed antibiotic treatment for 14 days.
Laboratory tests showed leukocytosis and anemia with hematocrit of 30%.
Twelve hours after admission, the patient was already stabilized, upper gastrointestinal endoscopy (UGEV) was performed, showing necrotizing mucosa in the esophagus, areas of slough, stomach erosions.
Biopsy confirmed NE.
She had no history of caustic ingestion or corrosive substances.
The previous image was compared with a normal LVDA.
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Proton pump inhibitors were administered intravenously, sucralfate orally and added to previous antibiotic treatment, metronidazole 500 mg/every 8 h for seven days.
Chest computed axial tomography (CAT) showed thickening of the esophageal wall with mucosal predominance in all its extension.
Three days after admission, an esophageal-stomach-duty reflux radiograph showed good esophageal passage, gastroesophageal reflux in the lower third of the esophagus with irregular mucosa and thick folds.
There was no contrast leak.
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He started eating at 96 hours, with good tolerance.
And finally settled down.
The VEDA was repeated at the month of diagnosis, which was normal.
