Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6493
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
Processing time: 111 Days and 18.9 Hours
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.
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.
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.