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Acute Esophageal Necrosis and Valproate Induced Acute Pancreatitis in a COVID-19 Patient

A 76-year-old man with a history of hypertension and chronic kidney disease presented with COVID-19 infection, hyperactive delirium, acute kidney injury, and hypotension. He developed acute pancreatitis as a complication of valproate therapy used to treat agitation. Poor oral intake, new onset dysphagia, hematemesis and lactic acidosis led to the diagnosis of acute esophageal necrosis on esophagogastroduodenoscopy (EGD). Valproate-induced pancreatitis is a rare complication and is more common in children and young adults. Acute esophageal necrosis, characterized by circumferential, black-appearing, distal esophageal mucosa, is associated with hypoperfusion and acid reflux.