Phlegmonous Gastritis Associated with Group A Streptococcal Toxic Shock Syndrome

Morimoto, Masaharu; Tamura, Shinobu; Hayakawa, Takahiro; Yamanishi, Hirofumi; Nakamoto, Chiaki; Nakamoto, Hiromichi; Ikebe, Tadayoshi; Nakano, Yoshio; Fujimoto, Tokuzo

doi:10.2169/internalmedicine.53.2741

Cited by 10 publications

(9 citation statements)

References 20 publications

(34 reference statements)

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“…EGD findings show an edematous mucosa with fibrinopurulent exudates and superficial ulcerations, loss of rugae, and poor distensibility; however, these features are nonspecific to PG. Several differential diagnoses need to be considered, like acute gastric mucosal lesion, scirrhous gastric cancer, gastric syphilis, corrosive gastritis, malignant lymphoma of the stomach, gastrointestinal stromal tumor, and anisakiasis[ 16 , 35 ]. Each of these diseases is diagnosed according to the collective findings from EGD imaging examination along with patient data on clinical pattern, medical history, and culture test results.…”

Section: Discussionmentioning

confidence: 99%

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Yang¹,

Kuo²,

Kang³

2022

World J Clin Cases

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BACKGROUND Phlegmonous gastritis (PG) is a rare bacterial infection of the gastric submucosa and is related to septicemia, direct gastric mucosal injury, or the direct influence of infection or inflammation in neighboring organs. Here, we present a patient who had spontaneous biloma caused by choledocholithiasis and then PG resulting from bile leakage after biloma drainage. CASE SUMMARY A 79-year-old man with a medical history of hypertension had persistent diffuse abdominal pain for 4 d. Physical examination showed stable vital signs, icteric sclera, diffuse abdominal tenderness, and muscle guarding. Laboratory tests showed hyperbilirubinemia and bandemia. Contrast computed tomography (CT) of the abdomen showed a dilated common bile duct and left subphrenic abscess. Left subphrenic abscess drainage revealed bilious fluid, and infected biloma was confirmed. Repeated abdominal CT for persistent epigastralgia after drainage showed gastric wall thickening. Esophagogastroduodenoscopy (EGD) showed an edematous, hyperemic gastric mucosa with poor distensibility. The gastric mucosal culture yielded Enterococcus faecalis . PG was diagnosed based on imaging, EGD findings, and gastric mucosal culture. The patient recovered successfully with antibiotic treatment. CONCLUSION PG should be considered in patients with intraabdominal infection, especially from infected organs adjacent to the stomach.

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Section: Discussionmentioning

confidence: 99%

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Yang¹,

Kuo²,

Kang³

2022

World J Clin Cases

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“…However, surgical treatment is required in resistant or severe cases [ 12 ]. Given that fatal cases were occasionally reported, physicians need to make a correct diagnosis and start the appropriate treatment [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Phlegmonous gastritis: a case series

2021

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Background Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. Case presentation Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. Conclusion In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.

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“…Previous studies have identified the risk factors of PG: advanced age, infection, malnutrition, diabetes, immunosuppression, ulcer, achlorhydria, gastric mucosal injury from chronic gastritis, and gastric cancer. [ 6 , 8 , 23 ] Patients with hematological malignancies are commonly immunocompromized due to prolonged neutropenia, intensive chemotherapy, and the disease itself. Indeed, there are a few reports of PG occurring within days of immunosuppresant therapy.…”

Section: Discussionmentioning

confidence: 99%

Gastric lymphoma complicated by phlegmonous gastritis and Guillain–Barré syndrome

Kuriyama¹,

Koyama²,

Tsuto³

et al. 2020

Medicine

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Introduction: Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain–Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. Patient concerns: A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. Diagnoses: DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. Interventions: The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. Outcomes: Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. Conclusion: PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.

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Phlegmonous Gastritis Associated with Group A Streptococcal Toxic Shock Syndrome

Cited by 10 publications

References 20 publications

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Phlegmonous gastritis after biloma drainage: A case report and review of the literature

Phlegmonous gastritis: a case series

Gastric lymphoma complicated by phlegmonous gastritis and Guillain–Barré syndrome

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