Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3741-3745
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3741
Fulminant phlegmonitis of the esophagus, stomach, and duodenum due to Bacillus thuringiensis
Hisatake Matsumoto, Hiroshi Ogura, Masafumi Seki, Mitsuo Ohnishi, Takeshi Shimazu
Hisatake Matsumoto, Hiroshi Ogura, Mitsuo Ohnishi, Takeshi Shimazu, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
Masafumi Seki, Division of Infection Control and Prevention, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
Author contributions: Matsumoto H participated in data acquisition and drafted the manuscript; Ogura H contributed to the critical appraisal of the manuscript; Seki M made critical contributions to the analysis of data and the drafting of the manuscript; Ohnishi M contributed to the drafting of the manuscript; and Shimazu T supervised the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hisatake Matsumoto, MD, Staff Physician, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan. h.matsumoto0828@gmail.com
Telephone: +81-6-68795707 Fax: +81-6-68795720
Received: August 20, 2014
Peer-review started: August 21, 2014
First decision: October 29, 2014
Revised: November 17, 2014
Accepted: December 20, 2014
Article in press: December 22, 2014
Published online: March 28, 2015
Processing time: 221 Days and 17.5 Hours
Abstract

We report a case of phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Culture of gastric juice and blood yielded Bacillus thuringiensis. This case showed that even low-virulence bacilli can cause lethal gastrointestinal phlegmonous gastritis in conditions of immunodeficiency.

Keywords: Phlegmonous gastritis; Esophagus; Duodenum; Bacillus thuringiensis; Immunocompromised state

Core tip: This is the first reported case of Bacillus thuringiensis as the suspected causative agent of rapidly progressive and fatal phlegmonitis of the esophagus, stomach, and duodenum in patient in an immunocompromised state. Even low-virulence bacilli may be a causative pathogen of gastrointestinal phlegmonitis in patients in an immunocompromised state.