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Wang T, Xiao P, Xue J, Ma J, Zheng C. Abdominal pain in an adolescent girl with acute phlegmonous gastritis: a case report. J Int Med Res 2023; 51:3000605231202136. [PMID: 37968062 PMCID: PMC10652809 DOI: 10.1177/03000605231202136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 08/30/2023] [Indexed: 11/17/2023] Open
Abstract
Acute phlegmonous gastritis (APG), a rare clinical condition, is mainly characterized by bacterial invasion in the gastric lining and is associated with a high mortality rate. The symptoms of APG include abdominal pain, nausea, vomiting, fever, and infection. Notably, the lack of specificity in the clinical presentation presents challenges in the early diagnosis of the disease. APG is often prevalent in adults, with a higher incidence in men than women. However, patients of other ages may also be affected. We herein present a case report of a 12-year-old girl who was admitted to the hospital with gastrointestinal symptoms and fever. The patient's imaging findings were compatible with APG. Despite the requirement for surgical treatment in most cases of phlegmonous gastritis, our patient rapidly improved with imaging and antibiotic therapy. This case demonstrates the success of antibiotic therapy with early diagnosis.
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Affiliation(s)
- Tian Wang
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Peizhen Xiao
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Jiawen Xue
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Jiaojiao Ma
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
| | - Chunhua Zheng
- Guihang GuiYang Hospital, Guiyang City, Guizhou Province, China
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Czapka MT, Schrantz SJ. Phlegmonous gastritis: Evolving from surgical to medical disease. IDCases 2023; 32:e01777. [PMID: 37159573 PMCID: PMC10163626 DOI: 10.1016/j.idcr.2023.e01777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023] Open
Abstract
We present a case of phlegmonous gastritis, which is a rare, life-threatening infection involving transmural inflammation of the stomach of multiple possible etiologies. Historically this disease has required surgical management, including gastrectomy, which is quite morbid. Evolving literature suggests that antimicrobial therapy alone may be adequate treatment for this infection. The diagnosis of phlegmonous gastritis was suggested by radiology but confirmed by endoscopic pathology. This particular case is unique given the patient's age, lack of co-morbidities and being the first description of Helicobacter pylori with phlegmonous gastritis. We report on a specific successful antimicrobial regimen and duration of therapy, which has not been well documented elsewhere in the literature, which may be helpful to clinicians.
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Affiliation(s)
- Michael T. Czapka
- Correspondence to: University of Chicago Medical Center, 5841 S Maryland Avenue MC 5065, Chicago, IL 60637, USA.
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Sumiyama F, Sakaguchi T, Yamamichi K, Sekimoto M. Peritonitis caused by group A streptococcus: A case report and literature review. Int J Surg Case Rep 2022; 92:106839. [PMID: 35240481 PMCID: PMC8889339 DOI: 10.1016/j.ijscr.2022.106839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Group A streptococcus (GAS) occasionally causes life-threatening infections. We encountered a case of GAS peritonitis associated with bilateral salpingitis. CASE PRESENTATION A 56-year-old previously healthy woman suddenly experienced a fever of 40 °C and lower abdominal pain, and was taken to the emergency room. She exhibited a condition of severe sepsis with pan-peritonitis. Although an intra-peritoneal source of infection was not detected preoperatively, an exploratory laparotomy was performed at 3 h after her arrival. During the surgery, bilateral salpingitis was observed. Peritoneal drainage was performed. Meropenem was administered and she was extubated on the next day. GAS was detected in the vaginal fluid culture and ascitic fluid culture. Antibiotics therapy was completed on postoperative day 9 and the patient was discharged on day 10 without any complications. METHODS A literature review was performed using the following algorithm: "(group A streptococcus OR streptococcus pyogenes) AND (peritonitis)". All case reports and case series published in English after 1990 were reviewed. RESULTS Fifty-six reports including 65 cases were eligible. There was a strong sex difference, with 80% of cases being female. All patients had symptoms of peritonitis, 80% had high-grade fever, and 74% had shock. The average time from onset to start of treatment was 3.8 days. Abdominal surgeries were required in 80% of cases. Multiple organ failure developed in 23%, and the mortality rate was 4.6%. DISCUSSION GAS peritonitis is a rare but life-threatening disease. Emergency surgical exploration and drainage are required to prevent progression to multiple organ failure.
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Affiliation(s)
- Fusao Sumiyama
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | | | - Keigo Yamamichi
- Department of Surgery, Kansai Medical University, Osaka, Japan
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Elisabeth P, Cornelia M, Athinna S, Anastasia A, Apostolos A, George D. Phlegmonous Gastritis and Streptoccocal Toxic Shock Syndrome: An Almost Lethal Combination. Indian J Crit Care Med 2021; 25:1197-1200. [PMID: 34916756 PMCID: PMC8645801 DOI: 10.5005/jp-journals-10071-23997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We report a case of phlegmonous gastritis in a 70-year-old woman without any predisposing factors, presenting with high fever, epigastric pain, and vomiting complicated by septic shock and multi-organ failure. The ultrasound and the computed tomography scan showed thickening of the stomach wall. Streptococcus pyogenes was isolated in the blood, thereby establishing the diagnosis of streptococcal toxic shock syndrome. An exploratory laparotomy excluded the need for a gastrectomy, and the patient was successfully treated with antibiotics. A short review of phlegmonous gastritis caused by S. pyogenes during the last 12 years is also presented. How to cite this article: Elisabeth P, Cornelia M, Athinna S, Anastasia A, Apostolos A, George D. Phlegmonous Gastritis and Streptoccocal Toxic Shock Syndrome: An Almost Lethal Combination. Indian J Crit Care Med 2021;25(10):1197-1200.
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Affiliation(s)
- Paramythiotou Elisabeth
- Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mitrakou Cornelia
- Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Savva Athinna
- Department of Internal Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antoniadou Anastasia
- Department of Internal Medicine, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Armaganidis Apostolos
- Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimopoulos George
- Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
BACKGROUND Invasive group A streptococci infections in pregnancy have historically led to severe maternal and neonatal morbidity and mortality. We are reporting a rare and novel case of successful treatment of third-trimester group A streptococci infection with early, aggressive intervention and maintenance of the pregnancy to term. CASE A 35 year old woman initially presented with fever, flu-like symptoms, and preterm contractions at 34 weeks of gestation. She demonstrated signs of early stages of septic shock, ultimately attributed to group A streptococci bacteremia. Early, aggressive intervention allowed the pregnancy to continue until 38 weeks of gestation with normal maternal and neonatal outcomes. CONCLUSION Early and aggressive treatment of invasive group A streptococci infection during pregnancy can potentially avoid severe maternal and perinatal morbidity and mortality with a successful continuation of pregnancy.
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Kato K, Tominaga K, Sugimori S, Nagami Y, Kamata N, Yamagami H, Tanigawa T, Shiba M, Watanabe T, Fujiwara Y, Arakawa T. Successful Treatment of Early-Diagnosed Primary Phlegmonous Gastritis. Intern Med 2015; 54:2863-6. [PMID: 26567999 DOI: 10.2169/internalmedicine.54.4257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
A 64-year-old man presented with epigastralgia and nausea after an acute exacerbation of chronic pancreatitis. Abdominal computed tomography revealed remarkable thickening of the gastric wall and intramural hypodense areas. Esophagogastroduodenoscopy showed a large gastric ulcer surrounded by an edematous mucosa and mucopus. The results of a culture from a biopsy of the lesion indicated phlegmonous gastritis. The patient was successfully treated with an antibiotic without gastrectomy.
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Affiliation(s)
- Kunihiro Kato
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol 2014; 20:3383-3387. [PMID: 24696618 PMCID: PMC3964411 DOI: 10.3748/wjg.v20.i12.3383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/31/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient’s clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient’s condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.
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Ajibe H, Osawa H, Yoshizawa M, Yamamoto H, Satoh K, Koinuma K, Morishima K, Hosoya Y, Yasuda Y, Sugano K. Phlegmonous gastritis after endoscopic submucosal dissection for early gastric cancer. Therap Adv Gastroenterol 2011; 1:91-5. [PMID: 21180517 DOI: 10.1177/1756283x08095746] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 74-year-old man with diabetic nephropathy developed epigastric pain and high fever after endoscopic submucosal dissection (ESD) for early gastric cancer. Gastroscopy, endoscopic ultrasonography and computed tomography showed ulceration with a purulent lake, thickened entire gastric mucosal layers suggesting focal abscess formation, leading to the diagnosis of phlegmonous gastritis. He underwent total gastrectomy as an emergency. Histological findings of the resected specimen showed severe inflammatory cell infiltration and multiple focal abscess formation spreading to the entire gastric wall. In patients with poorer general conditions, phlegmonous gastritis should be considered as a serious complication after ESD, indicating a requirement of antibiotic prophylaxis.
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Affiliation(s)
- Hironari Ajibe
- Department of Internal Medicine, Division of Gastroenterology Jichi Medical University, Tochigi, Japan
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Paik DC, Larson JD, Johnson SA, Sahm K, Shweiki E, Fulda GJ. Phlegmonous gastritis and group A streptococcal toxic shock syndrome in a patient following functional endoscopic sinus surgery. Surg Infect (Larchmt) 2010; 11:545-9. [PMID: 20575666 DOI: 10.1089/sur.2009.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Phlegmonous gastritis is a rare and often fatal condition that can affect healthy individuals in 50% of cases. The condition has been described in accounts dating back to the pre-antibiotic era, during which time mortality was nearly 100%. Over the past century, case reports average about one per year. The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection. METHODS A case report was presented and the pertinent literature was reviewed. CASE REPORT A 45-year-old man with a history of recent paranasal sinus surgery presented with acute abdominal pain and criteria consistent with toxic shock syndrome. Computed tomography scan showed diffuse thickening of the gastric wall and free intraperitoneal fluid. Exploratory laparotomy revealed a thickened stomach wall with outer fibrinous exudate and murky peritoneal fluid, which grew Streptococcus pyogenes. Intraoperative esophagogastroduodenoscopy revealed thickened gastric folds with a "cobblestone" appearance and no evidence of perforation. He was treated with antibiotics intravenously and sustained a difficult intensive care unit course complicated by ventilator-dependent respiratory failure, renal failure, and coagulopathy, but survived without major disability. CONCLUSIONS This is an unusual case presentation of a rare but potentially lethal condition, whose optimal treatment is unclear. Phlegmonous gastritis should be considered when isolated gastric wall thickening is encountered in the clinical setting of toxic shock syndrome.
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Affiliation(s)
- David C Paik
- Department of Surgery, Christiana Care Health System, Christiana Hospital, Newark, DE, USA.
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Yamada T, Yamada T, Yamamura MK, Katabami K, Hayakawa M, Tomaru U, Shimada S, Morikawa M, Seki T, Ariga S, Ishikawa K, Ikebe T, Gando S, Minakami H. Invasive group A streptococcal infection in pregnancy. J Infect 2010; 60:417-24. [DOI: 10.1016/j.jinf.2010.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 12/18/2022]
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Phlegmonous gastritis in a patient with myeloid sarcoma: a case report. Appl Immunohistochem Mol Morphol 2010; 17:458-62. [PMID: 19644358 DOI: 10.1097/pai.0b013e31819f86e2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Phlegmonous gastritis is a rare acute bacterial infection of the gastric wall with an extremely high mortality rate. Early diagnosis is crucial for immediate treatment that could improve the outcomes. Here we report a case in which a patient with underlying chronic myelomonocytic leukemia was diagnosed with phlegmonous gastritis on biopsy. This 57-year-old man presented with shortness of breath and intermittent upper quadrant abdominal pain for 4 days. Laboratory tests showed markedly increased white blood cell. A diagnosis of chronic myelomonocytic leukemia was made based on a peripheral blood smear and flow cytometry. Gastric biopsy showed suppurative inflammation in the submucosal region, prompting the diagnosis of phlegmonous gastritis. The patient was given empirical antibiotic treatment, and the white blood cell decreased dramatically. Surgical intervention was discussed but deferred. Despite continued antibiotics treatment, the patient died. The limited autopsy confirmed the diagnosis of phlegmonous gastritis. Immunohistochemical studies further revealed the occurrence of myeloid sarcoma that involved the gastrointestinal tract.
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