First documented case of <i>Sarcina</i> in esophageal brushing cytology

Shetty, Nishka; O'Connell, Josephine; Oshilaja, Olaronke; Patil, Deepa T.; Procop, Gary W.; Sturgis, Charles D.

doi:10.1002/dc.23986

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…To our knowledge, this is the first reported case of Sarcina in a pyloric/duodenal brushing specimen. A recent report did note Sarcina in an oesophageal brushing 3. This patient's oesophageal biopsy taken simultaneously did not demonstrate the organism.…”

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confidence: 59%

First report of Sarcina ventriculi in a pyloric and duodenal brushing specimen

2019

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Dear Editor,Sarcina ventriculi is an anaerobic Gram-positive coccus that in tissue is arranged in a characteristic tetrad shape. It is usually incidentally found on gastric biopsy in the setting of gastric stasis. 1,2We present a case of Sarcina found by cytological examination of a pyloric and duodenal brushing.The patient is a 38-year-old male immigrant from Guatemala with a past medical history significant for Hodgkin's disease in remission. He presented to a local primary care provider for nausea, frothy emesis, occasional haematemesis and early satiety; he was then referred to a gastroenterologist for endoscopy. Upper endoscopy revealed a circumferential pre-pyloric ulcerative lesion and a separate pyloric ulcer extending into the duodenum. Biopsy of the circumferential lesion demonstrated poorly differentiated diffuse-type gastric adenocarcinoma with signet ring cells. A brushing of the pyloric/duodenal ulcer was prepared on a ThinPrep® 2000 Processor (Hologic). Papanicolaou stain showed non-malignant squamous, gastric and duodenal mucosa with rare acute and chronic inflammatory cells. Interspersed and loosely adherent to the mucosal surface were large, haematoxylinfast cuboidal cells arranged in tetrads and packets (Figure 1, 200×). These cuboidal cells stained prominently with Grocott's methenamine silver (Figure 1 inset, 400×). These findings are most consistent with S. ventriculi. To our knowledge, this is the first reported case of Sarcina in a pyloric/duodenal brushing specimen. A recent report did note Sarcina in an oesophageal brushing. 3 This patient's oesophageal biopsy taken simultaneously did not demonstrate the organism. First discovered in a dyspeptic patient in 1842 and first cultured in 1905, Sarcina is ubiquitous in the environment and is associated with bloating disease in livestock. 4 In humans, S. ventriculi is associated with gastric stasis of any aetiology, but evidence suggests that the organism does not directly injure gastric mucosae in humans and does not have a causative role in ulcerative or static disease. 1,4Rather, the organism is most likely to be able to grow only in the presence of gastric stasis or outlet obstruction. 1,4 This patient's gastric adenocarcinoma was probably the proximate cause of gastric stasis, which allowed Sarcina to flourish.Our findings also suggest that duodenal brushing cytology is sensitive enough to find Sarcina. In addition to upper gastrointestinal cancer diagnosis, 5 historical studies found brush cytology to be sensitive for detection of other bacteria 6 and yeast. 7 Micrococcus species are a potential morphological confounder and can sometimes be arranged in tetrads; however, this organism was significantly larger than expected for Micrococcus and was not arranged in large clusters, a characteristic of Micrococcus species. 4Currently, microbiological workup (culture, sensitivities, molecular genotyping/phenotyping) is not routinely performed for Sarcina because of the lack of causative relationship with disease. However, the presence of Sarcina...

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confidence: 59%

First report of Sarcina ventriculi in a pyloric and duodenal brushing specimen

2019

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“…The pathogenic role of Sarcina ventriculi in humans is not entirely understood despite an increasing number of reported cases. It has been isolated in blood [ 13 , 14 ], as well as esophageal, pyloric and duodenal brushings [ 15 - 16 ], fine-needle aspirations of the stomach [ 17 ], and tissue biopsies of the stomach [ 18 ]. It has also been implicated in esophageal stricturing [ 19 ] along with emphysematous gastritis and fatal perforations.…”

Section: Discussionmentioning

confidence: 99%

Non-operative Management of Sarcina ventriculi-Associated Severe Emphysematous Gastritis: A Case Report

Birkholz¹,

Niehaus²,

Conrad-Schnetz³

2022

Cureus

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We report a case of a 64-year-old Jehovah's Witness male, who was post-operative day five of laparoscopic cholecystectomy. He presented with anemia, severe ischemic gastritis, and pneumatosis seen on CT with intravenous contrast. A subsequent upper endoscopy revealed patchy gastric ulceration with bleeding but no overt evidence of perforation. Biopsies were taken, and immunohistological staining identified Sarcina ventriculi. The patient was treated non-operatively with fluconazole and piperacillin-tazobactam for the infection and with sucralfate tablets and pantoprazole injections for ulcer treatment. After five days, a repeat CT scan revealed a resolved pneumatosis. S. ventriculi is a rare bacterium that is increasingly being reported as a cause of emphysematous gastritis with potentially fatal perforation. Surgical intervention should be reserved for unstable patients with perforations and significant, overt bleeding. In this case, nonoperative treatment with antibiotics and proton pump inhibitor (PPI) medications were preferred in the setting of anemia in a Jehovah's Witness patient without perforation. The patient showed clinical and radiologic improvement. Further understanding of the role of surgical intervention versus non-operative management is needed for this rare and potentially life-threatening organism.

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“…In the medical literature, the cases reported are associated with a variety of anatomical or functional conditions associated with gastric stasis, such as: gastric or esophageal adenocarcinoma in five cases, 9,19,24,34 laparoscopic gastric banding in four cases, 20,22,23,26 post gastrectomy with gastroenteroanastomosis and vagotomy, 10 psychomotor retardation or neurological deficit with gastrostomy for feeding in three cases, 28,42 benign pyloric or duodenal mass, 7,9,11,32 Schatzki's ring, 27 gastroparesis secondary to diabetes mellitus; 6,9,31 among other conditions.…”

Section: Discussionmentioning

confidence: 99%

Sarcina ventriculi a rare pathogen

et al. 2021

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Sarcina ventriculi is a gram-positive bacterium, able to survive in extreme low pH environment. It's first description dates from 1842, by John Goodsir. Since then, just a few cases have been reported. In veterinary medicine, especially in ruminants, it causes bloating, vomiting, gastric perforation and death of the animal. It is commonly associated with delayed gastric emptying or obstruction to gastric outlet, although it's pathogenicity in humans is not fully understood. We report two cases with identification of the bacteria in gastric specimens stained with hematoxylin-eosin staining, in different clinical settings. The first patient is a young female patient, presenting cardiac arrest and death after gastric perforation and the second patient an adult male presenting with gastric adenocarcinoma, treated with partial gastrectomy followed by adjuvant chemoradiation. In our literature review, we identified forty-five cases reporting Sarcina ventriculi appearance, with a sudden increase since 2010.

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First documented case of Sarcina in esophageal brushing cytology

Cited by 7 publications

References 13 publications

First report of Sarcina ventriculi in a pyloric and duodenal brushing specimen

First report of Sarcina ventriculi in a pyloric and duodenal brushing specimen

Non-operative Management of Sarcina ventriculi-Associated Severe Emphysematous Gastritis: A Case Report

Sarcina ventriculi a rare pathogen

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