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Summary: “Black esophagus”, also known as acute esophageal necrosis (AEN), is a relatively rare disease characterized by black discoloration of the esophageal mucosa. The condition can be located only distally, but it can also affect the entire esophagus. Hematemesis is the most common clinical manifestation is; the condition is associated with increased lethality in high-risk groups of patients. Early diagnosis of AEN can be made by gastroscopy, the initiation of adequate treatment is crucial for a favorable patient prognosis. The most serious complications of AEN include esophageal perforation with the risk of other complications such as mediastinitis and sepsis. The nature of the disease and the affection of the esophagus and potentially the mediastinum require a multidisciplinary approach. Below we present a case report of a 68-year-old patient with a diagnosis of AEN complicated by perforation confirmed by CT and early endoscopy. An endoscopic approach with the introduction of a fully coated metal stent was chosen as the primary solution for the esophageal perforation. Nevertheless, the patient developed other complications of perforation: mediastinitis and empyema requiring chest drainage. In addition to interventional methods, the patient was treated with broad-spectrum antibiotics and a combination of parenteral and enteral nutrition. After 3 months of treatment and resolving the complications, the patient was released to outpatient care in a good clinical condition. Key words: acute esophageal necrosis – oesophageal perforation – mediastinitis – Danis stent – metallic stent

Functional hyposplenism is a condition accompanying many diseases including autoimmune disorders and lymphomas. Hyposplenism is also commonly found in adult coeliac disease (up to 20 % of non-complicated and up to 80 % of complicated disease). Hyposplenism is associated with an increased risk of severe infections ( Streptococcus pneumoniae , Neisseria meningitidis and Haemophilus influenzae ). The aim of this prospective study was to investigate memory B lymphocytes as an indirect biomarker of functional hyposplenism. A total of 42 patients with coeliac disease (11 men, 31 women; mean age 49±14 years) and 10 healthy controls, blood donors (2 men, 8 women; mean age 39±7 years) were enrolled into the study. Nobody underwent previous splenectomy and no individual suffered from immunodeficiency. The DuraClone IM panel was used to identify B lymphocytes subpopulations in peripheral blood samples by flow cytometry Navios (Beckman Coulter) with software analysis using Kaluza version 1.2. Patients with coeliac disease and controls did not differ in basic parameters of leukocyte and total lymphocyte blood count. Switched memory B lymphocytes (CD19+CD27+IgD-), non-switched memory / marginal-zone-like B lymphocytes (CD19+CD27+IgD+) and IgM memory B lymphocytes (CD19+CD27+IgM++) were significantly lower in coeliac disease compared to controls. Follicular (naive) B lymphocytes were not significantly different between coeliac disease and controls. In conclusion, dysfunction of memory B lymphocytes can be responsible for an increased risk of severe bacterial infections in coeliac disease. Patients with coeliac disease with dysfunction of memory B lymphocytes are clearly indicated for anti-pneumococcal vaccination.