Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 1 2023 07 17 21 23 Narjes Zarei Jalalabadi Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Nasim Khajavirad Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Samaneh Parsa Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. Sahar Karimpour Reyhan Department Internal medicine, Imam Khomeini Hospital complexs,Tehran University of Medical Sciences, Tehran, Iran. 2021 10 31 2023 02 12 Nowadays People use herbal medicines to try to maintain or improve their health but sometimes they cause side-effects and some herbal drug may also interact with medication. We reported a 37 -year-old man who presented to the emergency department with sever watery diarrhea, vomiting, dysphagia, bicytopenia, renal failure and Acute esophageal necrosis, also known as black esophagus which is a rare syndrome characterized by a striking diffuse circumferential black appearance of the esophageal mucosa that universally affects the distal esophagus, 2-days after use of herbal drug named suranjan. Suranjan is a herbal formulation used to treat Rheumatoid arthritis. https://crcp.tums.ac.ir/index.php/crcp/article/view/615