Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Black Esophagus (Acute Necrotizing Esophagitis) and Wischnewsky Lesions in a Death From Diabetic Ketoacidosis

A Possible Underlying Mechanism

McCarthy, Sinead, MBChB, DTM&H*; Garland, Jack, BMed; Hensby-Bennett, Sarah, BSc (Hons), MBChB; Philcox, Winston, BHSc§; Kesha, Kilak, MD*; Stables, Simon, MBChB, MNZM, DAvMed, AsFACAsM, FNZSP, FRCPA*; Tse, Rexson, MB, BS, BSc, FRCPA*

The American Journal of Forensic Medicine and Pathology: June 2019 - Volume 40 - Issue 2 - p 192–195
doi: 10.1097/PAF.0000000000000463
Case Reports

Acute esophageal necrosis (AEN), also known as black esophagus, is a rare clinical entity. It is recently described to be associated with diabetic ketoacidosis (DKA) in a few case reports. Wischnewsky lesions (WLs) are a classic postmortem finding seen in fatal hypothermia but are recently described to be associated with DKA. Interestingly, the pathogenesis and morphology of AEN and WLs appear to share similar characteristics. Both AEN and WLs are reported to be seen simultaneously in hypothermic deaths and deaths related to alcohol abuse, but not in DKA. We report a death in a 67-year-old woman who died of DKA. At postmortem examination, the esophagus and stomach showed AEN and WLs, respectively. Although not previously reported together, both AEN and WLs have separately been described in cases of DKA. This case raises a possible unifying etiology of AEN and WLs in DKA (and probably also in hypothermic deaths and deaths related to alcohol abuse), manifested in different parts of the gastrointestinal tract.

From the *Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand;

Hornsby Ku-Ring-Gai Hospital, Hornsby, New South Wales, Australia; and

Waikato District Health Board, Waikato; and

§Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Manuscript received October 19, 2018; accepted December 8, 2018.

The authors report no conflict of interest.

Reprints: Rexson Tse, MB, BS, BSc, FRCPA, Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland 1148, New Zealand. E-mail:;

© 2019 by Lippincott Williams & Wilkins.