Endoscopic Portrayal of Lymphocytic Gastritis in a Child

Abstract

A 14-year-old girl presented for endoscopic examination after 4 months of abdominal pain in the right upper quadrant and epigastric area. The endoscopic examination showed a spectacular rash of raised erythematous aphthoid-like ulcerations with a white coating (Fig. 1). Histologic study showed intense superficial plasmacytosis and overlying regions of lymphocytic congestion consistent with the diagnosis of lymphocytic gastritis (LG), first defined by Haot et al in 1985 (1), >25 intraepithelial lymphocytes/100 epithelial cells (Figs 2 and 3 ) (2). The patient's biopsies were found to be negative for celiac disease and Helicobacter pylori. Her symptoms improved with sucralfate and Prevacid. She later developed worsening right upper quadrant pain and was diagnosed as having chronic cholecystitis. Postcholecystectomy, the repeat endoscopic and histologic examination done for residual abdominal pain showed resolution of LG.Although we do not understand the pathogenesis of LG, this case may be related to 1 of the proposed etiologies of LG involving immunologic intolerance of the gastric mucosa to environmental agents (3). The patient most likely had resolution of her findings with the removal of the offending agent. At this point we are unable to predict at what stage in the pathologic process the gross and/or the microscopic findings of LG will be apparent (4). It may be related to the acuteness and severity of the insult, or the phase of the disease process. In the future, including endoscopic examination of gross pathology in investigations of LG may help to further define the natural history of the disease. This case does not represent any of the known causes of LG (3,(5)(6)(7)(8). In this patient the role of cholecystitis is not clear.