Phlegmonous Gastritis: A Case Report of Successful Early Antibiotic Treatment

Abstract

Phlegmonous gastritis (PG) is a rare and serious bacterial infection of the gastric submucosa. Diagnosis is often delayed due to nonspecific symptoms, but if recognized early, PG may be treated successfully with medical therapy alone. We describe a case of a 47-year-old patient admitted with gastrointestinal symptoms and sepsis. He was found to have beta-hemolytic streptococcus bacteremia with a purulent gastric ulcer on endoscopic evaluation, consistent with the diagnosis of PG. Though surgical evaluation is often required in cases of PG, our patient quickly improved with parenteral antibiotic therapy. This case highlights an uncommon source of sepsis and demonstrates the success of antibiotic monotherapy with early recognition.

A Rare Case of Phlegmonous Gastritis in a Previously Healthy Male: A Case Report

“…PG is categorized into two subgroups based on lesion range, localized and diffuse. Diffuse PG has a higher overall mortality compared to localized PG (54% vs. 10%, respectively) [3][4][5]. Diffuse PG is more common and characterized by a generalized thick, dark, and red gastric wall with purulent discharge when pressure is applied to the gastric wall.…”

“…Imaging such as a CT scan is a great initial test that can detect gastric wall thickening; however, it is not routinely recommended, and most patients warrant direct visualization and biopsy for accurate diagnosis. Endoscopic findings include fibrinopurulent exudates that line the stomach, erosions of the stomach that can extend to the duodenum, and edematous mucosa [5]. Histopathologic findings can include neutrophils, plasma cells, and intramural hemorrhage with necrosis [1,[6][7][8].…”

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

“…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.…”