15 August 2023
: Case report 
Acute Esophageal Necrosis as a Rare Complication of Metabolic Acidosis in a Diabetic Patient: A Case Report
Challenging differential diagnosis
Salvatore Greco12ABEF, Antonio Giovine1ABEF, Cindy Rocchi1E, Riccardo Resca1E, Renato Bigoni1E, Luca Formigaro1E, Anna Grazia Angeletti1E, Nicolò Fabbri3E, Aurora Bonazza
4E*, Carlo V. Feo 35G
DOI: 10.12659/AJCR.939624
Am J Case Rep 2023; 24:e939624
Table 1. Laboratory findings.
| Blood tests | |||||
|---|---|---|---|---|---|
| Parameter | Normal value (range) | Patient’s value | Parameter | Normal value (range) | Patient’s value |
| WBC | 4.00–11.00 | 26.29×10/µL | Urea | 17–43 | 66 mg/dL |
| RBC | 4.50–6.50 | 5.39×10/µL | Creatinin | 0.50–1.20 | 0.90 mg/dL |
| Hb | 13.0–18.0 | 17.0 g/dl | eGFR | >90 | 86 ml/min |
| HCT | 40–54 | 47% | Total bilirubin | <1.20 | 4.41 mg/dL |
| MCV | 76–96 | 87 fl | Direct bilirubin | 0.00–0.30 | 0.65 mg/dL |
| MCH | 27.0–32.0 | 31.5 pg | Sodium | 136–145 | 130 mmol/L |
| MCHC | 30.0–35.0 | 36.4 g/dl | Potassium | 3.5–5.3 | 3.5 mmol/L |
| PLT | 150–450 | 367×10/µL | ALT | <50 | 17 U/L |
| Neutrophils | 2.00–7.50 | 22.97×10/µL | LDH | <248 | 102 U/L |
| Lymphocytes | 1.50–5.00 | 1.50×10/µL | CPK | <170 | 17 U/L |
| Monocytes | 0.20–1.00 | 1.77×10/µL | Lipase | <67 | 8 U/L |
| Eosinophils | 0.04–0.40 | 0.00×10/µL | TSH | 0.25–4.50 | 0.65 µU/mL |
| Basophils | 0.01–0.10 | 0.05×10/µL | CRP | <0.50 | 3.84 mg/dL |
| PT (INR) | – | 1.12 | HS Troponin I | <20 | 9 ng/L |
| PT (Ratio) | 0.80–1.20 | 1.12 | Procalcitonin | <0.5 | 0.14 ng/mL |
| PTT (Ratio) | 0.82–1.20 | 0.93 | Proteins | 6.6–8.4 | 7.6 g/dL |
| Fibrinogen | 150–400 | 478 mg/dL | Total cholesterol | <200 | 228 mg/dL |
| Glucose | 70–110 | 300 mg/dL | HDL cholesterol | >35 | 37 mg/dL |
| Triglycerides | <150 | 345 mg/dL | |||
| WBC– white blood cells; RBC – red blood cells; Hb – haemoglobin; HCT – haematocrit; MCV – medium corpuscular volume; MCH – mean corpuscular haemoglobin; MCHC – mean corpuscular haemoglobin concentration; PLT – platelets; PT(INR) – prothrombin time (international normalized ratio); aPTT – activated partial thromboplastin time; eGFR – estimated glomerular filtration rate; ALT – alanine transferase; LDH – lactate dehydrogenase; CPK – creatine phosphokinase; TSH – thyroid-stimulating hormone; CRP – C reactive protein; HBsAg – hepatitis B s antigen; HbsAb – anti-bepatitis B surface; CMV – cytomegalovirus; EBV – Epstein Barr virus; HIV – human immunodeficiency virus. Abnormal findings are reported with *0. | |||||
| Viral antibody tests | Fungal antigen tests | ||||
| Parameter | Normal value | Patient’s value | Parameter | Normal value | Patient’s value |
| HbsAg | <0.05 | <0.030 IU/mL | Galactomannan Antigen | <0.16 | 0.02 index |
| HBsAb | <10 | <3.00 UI/L | Beta-D-Glucan | ≤7 | <3 pg/mL |
| HbA1c | 23.0–43.0 | 56.0 mmol/mol | |||
| Anti-CMV IgG | – | 56 U/mL | |||
| Anti-CMV IgM | – | Negative | |||
| Anti-herpes simplex 1/2 IgG | <0.9 | >30.0 | Total CD3+ | 58–72 | 71% |
| Anti-herpes simplex 1/2 IgM | <0.9 | <0.500 | CD3+ CD4+ | 34–48 | 42% |
| Anti-herpes simplex 2 IgG | <0.9 | <0.500 | CD3+ CD8+ | 15–27 | 30% |
| Anti-Varicella-Zoster IgG | ≤134 | 1,776 | CD4/CD8 Ratio | 1.00–2.80 | 1.40 |
| Anti-Varicella Zoster IgM | <0.9 | 0.13 | Total CD3 | 603–2,990 | 1590/µL |
| Anti-EBV VCA IgG | <20 | 113 | CD4 | 441–2,156 | 933/µL |
| Anti-EBV VCA IgM | <20 | <10.0 U/mL | CD8 | 125–1,312 | 666/µL |
| HIV 1-2 | – | Negative | |||
| WBC– white blood cells; RBC – red blood cells; Hb – haemoglobin; HCT – haematocrit; MCV – medium corpuscular volume; MCH – mean corpuscular haemoglobin; MCHC – mean corpuscular haemoglobin concentration; PLT – platelets; PT(INR) – prothrombin time (international normalized ratio); aPTT – activated partial thromboplastin time; eGFR – estimated glomerular filtration rate; ALT – alanine transferase; LDH – lactate dehydrogenase; CPK – creatine phosphokinase; TSH – thyroid-stimulating hormone; CRP – C reactive protein; HBsAg – hepatitis B s antigen; HbsAb – anti-bepatitis B surface; CMV – cytomegalovirus; EBV – Epstein Barr virus; HIV – human immunodeficiency virus. Abnormal findings are reported with *0. | |||||