Phlegmonous gastritis and group A streptococcal toxic shock syndrome in a patient following functional endoscopic sinus surgery.
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.


METHODS
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.
Paik
David C
DC
Department of Surgery, Christiana Care Health System, Christiana Hospital, Newark, DE, USA. dcp14@columbia.edu
Larson
James D
JD
Johnson
Steven A
SA
Sahm
Katherine
K
Shweiki
Ehyal
E
Fulda
Gerard J
GJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004724:Endoscopy / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005756:Gastritis / Q000150:complications* / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010254:Paranasal Sinus Diseases / Q000601:surgery*; D011183:Postoperative Complications / Q000382:microbiology* / Q000473:pathology; D011860:Radiography, Abdominal; D012772:Shock, Septic / Q000382:microbiology* / Q000473:pathology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000473:pathology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D014056:Tomography, X-Ray; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents