P-464: Acute esophageal necrosis in the course of diabetic ketoacidosis in a pediatric patient – case report
W Bartnikowska, S Seget, M Holon, M Kałużny-Czyż, U Grzybowska-Chlebowczyk, P Jarosz-ChobotAbstract
Introduction
AEN is a rare condition characterized by peripheral necrosis of the esophageal mucosa, most often manifesting as hematemesis, and typically occurring in adults with comorbidities. Pediatric cases are exceptional and are typically associated with severe systemic disorders, such as sepsis or diabetic ketoacidosis (DKA).
Objectives
To present a rare case of AEN in children, a complication of DKA and sepsis, and to discuss its unusual clinical presentation.
Methods
A 12-year-old boy with poorly controlled type 1 diabetes (diagnosed at age 8) was admitted to the hospital in severe condition due to moderate DKA. Clinical evaluation including laboratory testing, imaging studies (abdominal ultrasound, CT scan), endoscopy, histopathological examination, and microbiological testing were performed.
Results
Laboratory investigations revealed metabolic acidosis (pH 7.18, HCO3- 14,9, glc 286), elevated inflammatory markers (CRP 195 mg/L, PCT >100 ng/mL), in a blood culture, Streptococcus pyogenes was isolated. On physical examination, notable findings included disproportionately severe epigastric pain, dehydration, and features of septic shock. Abdominal ultrasound demonstrated thickening of the gastric, esophageal, and duodenal walls. Computed tomography (CT) showed esophageal wall thickening, hyperemia and thickening of the gastric wall and cardia, as well as numerous mesenteric lymph nodes in the mid-abdomen. Endoscopic examination revealed fibrin-covered lesions in the distal esophagus, along with erosions and ulcerations of the stomach and duodenum. Histopathological evaluation of biopsy specimens confirmed esophageal necrosis. The patient was treated with broad-spectrum antibiotic therapy, antifungal agents, intravenous insulin therapy, and nutritional support, resulting in clinical and endoscopic improvement.
Conclusions
AEN is a rare complication of DKA and sepsis in children and requires early diagnosis and multidisciplinary treatment for recovery. Symptoms may be atypical, without hematemesis.