Emphysematous gastritis due to Sarcina ventriculi infection in a diabetic liver-kidney transplant recipient

Abstract

Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to Sarcina ventriculi in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant Sarcina ventriculi were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.

Sarcina ventriculi in an Endoscopic Ultrasound-Guided Fine Needle Aspiration of a Perigastric Lymph Node with Metastatic Pancreatic Adenocarcinoma: A Carry-Through Contaminant Bacterial Microorganism from the Stomach

“…This patient was status post pancreatico-duodenectomy. In our report, the extrinsic compression of the duodenum by the perigastric mass causing a partial gastric outlet obstruction and delayed gastric emptying provided favorable conditions, an acidic pH of the stomach and the presence of carbohydrates as nutrients, for the growth of Sarcina , with all of these factors correlating well to several published reports regarding the pathogenesis of this organism [ 3 , 14 , 15 ]. Sarcina ventriculi is typically histologically diagnosed from hematoxylin-eosin-stained sections taken from the mucosal tissue biopsies, but molecular methods such as polymerase chain reaction and sequencing of the 16S ribosomal RNA (rRNA) and the pyruvate decarboxylase gene, a unique metabolic pathway in S arcina , can also be used [ 12 ] to confirm the diagnosis.…”

“…It is challenging for pathologists to know the significance of Sarcina in clinical specimens, and as such, the presence of this microorganism should be reported to our clinical colleagues to allow for optimized patient management [ 13 ]. In some patients, bacterial proliferation and gastritis have been reported with signs of mucosal injury, concurrent diabetic gastroparesis, history of surgical scarring, or malignancies [ 14 ].…”

Emphysematous gastritis due to Sarcina ventriculi infection in an immunocompromised adult

“…This case is unique because there are no prior published reports of SV infection in a heart transplant recipient, and this is the first report of survival from SV infection in a solid organ transplant recipient. The only other report of SV in a solid organ transplant recipient was published in 2020, describing the course and eventual death of a liver‐kidney transplant patient with SV infection 8 . While their patient did not have pneumoperitoneum, the imaging and endoscopic features were very similar, with emphysematous gastritis, portal venous gas, gastric ulceration, and mucosal ischemia being present.…”

Recent Records on Bacterial Opportunistic Infections via the Dietary Route

“…The reports described in this review are summarized in Table S1 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], where the bacterial groups involved in the illnesses are reported in alphabetical order along where the type of ...…”