Introduction: Acute esophageal necrosis (AEN), or “black esophagus,” is a rare but serious condition that mainly occurs in elderly patients with vascular frailty and significant comorbidities. It is thought to result from acid injury combined with esophageal ischemia. It frequently presents with upper gastrointestinal bleeding. Diagnosis relies on esophagogastroduodenoscopy (EGD), which shows diffuse, circumferential black discoloration of the esophageal mucosa, predominantly distal and ending sharply at the Z-line. AEN may progress to severe complications, including esophageal stricture and perforation, and remains associated with high mortality. Case Presentation: We report the case of a 50-year-old man with alcohol-related liver cirrhosis, still actively drinking and not under medical follow-up, admitted for mild acute alcoholic pancreatitis. His course was complicated by delirium tremens in the setting of abrupt alcohol withdrawal. Clinically, he presented with blackish vomiting and melena. Laboratory tests revealed severe anemia (hemoglobin 6.3 g/dL), acute kidney injury, and severe hypokalemia requiring admission to the intensive care unit. EGD revealed grade D ulceronecrotic esophagitis according to the Los Angeles classification, without active bleeding, consistent with black esophagus syndrome. Biopsies were deferred given the acute bleeding context. Caustic ingestion was ruled out by history. The patient was managed with fluid resuscitation, parenteral nutrition, correction of fluid and electrolyte disturbances, high-dose intravenous proton pump inhibitor (PPI) therapy followed by double-dose oral PPI combined with sucralfate, and initial fasting. Follow-up EGD on day 8 showed marked improvement without esophageal stricture. The outcome was favorable, with resumption of oral feeding, continuation of PPI therapy for eight weeks, and referral to an addiction medicine clinic. Conclusion: Our case shows that early and optimal management can lead to healing of esophageal lesions. Control of comorbidities is an essential component of treatment, together with supportive resuscitative measures and combined PPI and sucralfate therapy. The outcome is often favorable, but mortality remains high owing to the frail background frequently associated with this condition.