Saito M, Morioka M, Izumiyama K, Mori A, Ogasawara R, Kondo T, Miyajima T, Yokoyama E, Tanikawa S. Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report. World J Clin Cases 2021; 9(22): 6493-6500 [PMID: 34435017 DOI: 10.12998/wjcc.v9.i22.6493]
Corresponding Author of This Article
Makoto Saito, MD, PhD, Chief Doctor, Department of Internal Medicine and Hematology, Aiiku Hospital, Chuo-ku Minami 4 Nishi 25, Sapporo 0640804, Hokkaido, Japan. ikyoku@aiiku-hp.or.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
Makoto Saito, Masanobu Morioka, Koh Izumiyama, Akio Mori, Reiki Ogasawara, Takeshi Kondo, Toru Miyajima, Emi Yokoyama, Department of Internal Medicine and Hematology, Aiiku Hospital, Sapporo 0640804, Hokkaido, Japan
Satoshi Tanikawa, Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 0608638, Hokkaido, Japan
Satoshi Tanikawa, Institute for Chemical Reaction Design and Discovery (WPI-ICReDD), Hokkaido University, Sapporo 001-0021, Hokkaido, Japan
Author contributions: All authors collected and analyzed the patient’s clinical data; Tanikawa S involved in pathological procedure; Saito M designed and wrote the manuscript; all authors agree to be accountable for all aspects of the work.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest in this work.
CARE Checklist (2016) statement: The manuscript was prepared according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Makoto Saito, MD, PhD, Chief Doctor, Department of Internal Medicine and Hematology, Aiiku Hospital, Chuo-ku Minami 4 Nishi 25, Sapporo 0640804, Hokkaido, Japan. ikyoku@aiiku-hp.or.jp
Received: April 7, 2021 Peer-review started: April 7, 2021 First decision: April 23, 2021 Revised: April 26, 2021 Accepted: May 24, 2021 Article in press: May 24, 2021 Published online: August 6, 2021
Abstract
BACKGROUND
Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is Streptococcus pyogenes, followed by Staphylococcus, Pneumococcus and Enterococcus. Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG.
CASE SUMMARY
The white blood cell count of a 70-year-old woman with acute lymphocytic leukemia in complete remission dropped to 100/μL after consolidation chemotherapy. Her vital signs were consistent with septic shock. Venous blood culture revealed the presence of Bacillus cereus. Abdominal computed tomography (CT) and esophagogastroduodenoscopy (EGD) showed marked thickening of the gastric wall. As with the other findings, CT was suggestive of HPVG, and EGD showed pseudomembrane-like tissue covering the superficial mucosa. Histopathological examination of gastric biopsy specimens showed mostly necrotic tissue with lymphocytes rather than neutrophils. Culture of gastric specimens revealed the presence of Bacillus cereus. We finally diagnosed this case as PG with Bacillus cereus-induced sepsis and HPVG. This patient recovered successfully with conservative treatment, chiefly by using carbapenem antibiotics.
CONCLUSION
The histopathological finding of this gastric biopsy specimen should be called "neutropenic necrotizing gastritis".
Core Tip: We reported a case of phlegmonous gastritis due to Bacillus cereus infection during the neutropenic phase after consolidation chemotherapy for acute lymphocytic leukemia. Including our 2 patients, we analyzed 7 similar patients reported in the past. Histopathological examination with gastric biopsy was performed only in our two patients, and in both cases, characteristic findings that should be called "neutropenic necrotizing gastritis" were observed.
