Phlegmonous gastritis in a patient with mixed-phenotype acute leukemia in the neutropenia phase during chemotherapy

Abstract

Rationale:Phlegmonous gastritis is a rare bacterial infection of the gastric wall with high mortality. However, diagnosis of phlegmonous gastritis is difficult and standard treatment remains unestablished.Patient concerns:We report a 33-year-old male patient with mixed-phenotype acute leukemia who developed acute phlegmonous gastritis during the neutropenia phase on induction chemotherapy and was successfully treated.Diagnoses:The patient was diagnosed with phlegmonous gastritis, which might be caused by Stenotrophomonas maltophilia on the basis of clinical manifestation, physical examination, enhanced computed tomography scan, histological finding, and microorganism culture of biopsied specimen in endoscopy.Interventions:The patient was treated with gastrointestinal decompression and broad-spectrum antibiotics.Outcomes:He recovered from phlegmonous gastritis and received the 2nd cycle of chemotherapy with no complaint of abdominal discomfort.Lessons:Early recognition and proper management including broad-spectrum antibiotics are key approaches to phlegmonous gastritis.

Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report

“…In general, hematological malignancies tend to be accompanied by a decrease in immunocompetence, and myelosuppression by the administration of anticancer drugs further promotes immunodeficiency. There have been 6 reports of patients with hematological malignancies who developed PG during the neutropenic phase after the administration of anticancer drugs, including 1 of our previous patients[ 9 - 14 ]. Table 2 summarizes the clinical features of a total of 7 patients, including the patient experienced this time.…”

“…It was reported that vonoprazan, a potassium-competitive acid blocker used in this patient, showed a stronger gastric acid secretion inhibitory effect than proton pump inhibitor and induced a stronger change in the composition of the intestinal flora[ 17 ]. Shi et al [ 14 ] expressed concern that the use of gastric acid secretion inhibitors increases the bacterial abundance in the gastric juice and thus may result in risk for the development of PG. Currently, there are few patients with PG with or without hematological malignancies, and scientific evidence is limited.…”

Phlegmonous gastritis complicated by abdominal compartment syndrome: a case report

“…Numerous bacterial organisms have been implicated as the most common pathogens; however, the Streptococcus genus accounts for approximately 67-75% of cases [1]. Diagnosis is difficult and requires a combination of clinical presentation, imaging, bacterial culture, and pathology [3].There is currently no consensus on the proper management of PG; however, mortality rates have been reported as high as 27% [1][2][3]. Therefore, early recognition and treatment with antibiotics is imperative.…”

A look inside the body of a BCR-ABL1-like acute lymphoblastic leukemia patient: the first case report highlighting the continued relevance of autopsy practice

“…The patient had pallor and moderate splenomegaly on clinical examination. His complete blood count (CBC) revealed a hemoglobin level of 78 g/L, platelet count of 9×10 9 /L, and white blood cell (WBC) count of 7.2×10 9 /L with 63% circulating blasts. Bone marrow aspirate showed 94% blasts.…”

“…TRALI and necrotizing enterocolitis were thought to be fungal infections and acute phlegmonous gastritis. These pathologies are rapidly fatal and require prompt measures for management [ 8 , 9 ]. Autopsy revealed different morphological subtypes of fungal species, which may require a different therapeutic approach [ 8 ].…”