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Phlegmonous Gastritis: A Rare Cause of Abdominal Pain

Flor-de-Lima, Filipa*; Gonçalves, Daniel*; Marques, Rita*; Silva, Cármen*; Lopes, Joanne; Silva, Roberto; Tavares, Marta*; Trindade, Eunice*; Carneiro, Fátima; Amil-Dias, Jorge*

Journal of Pediatric Gastroenterology and Nutrition: February 2015 - Volume 60 - Issue 2 - p e10
doi: 10.1097/MPG.0b013e318291ff1f
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*Unit of Pediatric Gastroenterology, Integrated Pediatric Hospital

Department of Pathological Anatomy, Centro Hospitalar de São João, Porto, Portugal.

Address correspondence and reprint requests to Filipa Flor-de-Lima, Unit of Pediatric Gastroenterology, Integrated Pediatric Hospital, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto 4202–451, Portugal (e-mail: filipa.flordelima@gmail.com).

Submissions for the Image of the Month should include high-quality TIF endoscopic images of unusual or informative findings. In addition, 1 or 2 other associated photographs, such as radiological or pathological images, can be submitted. A brief description of no more than 200 words should accompany the images. Submissions are to be made online at www.jpgn.org, and will undergo peer review by members of the NASPGHAN Endoscopy and Procedures Committee, as well as by the Journal.

The authors report no conflicts of interest.

Phlegmonous gastritis is a rare cause of acute, rapidly progressive (1,2), and severe bacterial infection of the gastric wall with poor prognosis, particularly if diagnosis is delayed or overlooked. Early diagnosis and aggressive antibiotic therapy seem to improve the outcome (3). A 7-year-old black boy was brought to the emergency department because of nausea, vomiting, epigastric pain, subfebrile body temperature, and malaise, 2 weeks after an acute tonsillitis. Physical examination revealed poor general aspect and generalized abdominal pain with no tenderness. Biochemical testing revealed leukocytosis with neutrophilia and elevation of both erythrocyte sedimentation rate and C-reactive protein. A necrotic lymph node next to the aorta was detected by abdominal ultrasound, and a computed tomography scan of the abdomen confirmed that abnormality and showed thickened gastric wall (Fig. 1). The upper gastrointestinal endoscopy showed gastric mucosa with hypertrophic folds, inflammation, and ulceration (Fig. 2). The histological examination showed lesions of acute gastritis, and the molecular analysis was positive for Streptococcus pneumoniae and Epstein-Barr virus (negative immunoglobulin M and positive immunoglobulin G) (Fig. 3). The child fully recovered after treatment with imipenem, without surgery. Because the diagnosis of phlegmonous gastritis usually occurs after surgery or autopsy, it is important to obtain a prompt diagnosis for successful treatment.

FIGURE 1

FIGURE 1

FIGURE 2

FIGURE 2

FIGURE 3

FIGURE 3

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REFERENCES

1. Park CW, Kim A, Cha SW, et al. A case of phlegmonous gastritis associated with marked gastric distension. Gut Liver 2010; 4:415–418.
2. Orel R, Mlinaric V, Stepec S, et al. Acute phlegmonous gastritis associated with Helicobacter heilmannii infection in a child. Dig Dis Sci 2006; 51:2322–2325.
3. Kim HS, Hwang JH, Hong SS, et al. Acute diffuse phlegmonous esophagogastritis: a case report. J Korean Med Sci 2010; 25:1532–1535.
© 2015 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,