PICTURES IN DIGESTIVE PATHOLOGY

 

A rare cause of emphysematous infectious gastritis

 

 

Jorge Galván-Fernández¹, María Isabel Jiménez-Cuenca¹, Isabel Molpeceres-Martínez¹ and María Luisa Álvarez-Quiñones²

Departments of ¹Radiodiagnosis and ²Pathology. Hospital Clínico Universitario de Valladolid. Valladolid, Spain

 

 

Case report

A 61-year-old man with a history of hypertension, type 2 diabetes, chronic renal failure, tuberculosis and peripheral arterial disease presented with gangrene in his right leg. A right supracondylar amputation was performed, despite which the patient continued with a high fever, oliguria and hypotension (90/50).

Laboratory work-up showed neutrophilic leukocytosis and metabolic acidosis. Computed tomography (CT) revealed pneumoperitoneum, emphysema and thickening of the gastric wall (Figs. 1 A and B). Changing the CT window we can appreciate air dissecting the layers of the gastric wall (Fig. 1C).

 

 

This clinical-radiological picture was consistent with emphysematous infectious gastritis, complicated with septic shock and the death of the patient despite treatment. The final histopathology reported gastric necrosis caused by mucormycosis affecting the entire thickness of the gastric wall and embolizing vessels.

 

Discussion

The incidence of mucormycosis is 1.7/1,000,000/year. Only 7% produces gastrointestinal infections and the reported mortality is around 85% (1). Risk factors include immunocompromised states such as diabetes (2).

It is essential to make a differential diagnosis between gastric emphysema and emphysematous gastritis, with different etiology and clinical management. Gastric emphysema is usually asymptomatic with a good prognosis, whereas emphysematous gastritis associated with gas-producing microorganisms has a poor prognosis, especially if it is associated with portal gas (3). Diagnosis of gastrointestinal mucormycosis requires a high index of suspicion because there are few reported cases in the literature. Definitive diagnosis is histological.

Successful treatment depends on early diagnosis, control of risk factors, early antifungal therapy and surgical debridement of necrotic tissue if necessary (4).

 

References

1. Lee ZJ, Chia C, Busmani I, Wong WK. A rare cause of ischemic gut: A case report. Int J Surg Case Rep 2016;20:114-7. DOI: 10.1016/j.ijscr.2016.01.018.         [ Links ]

2. Geramizadeh B, Modjalal M, Nabai S, et al. Gastrointestinal zygomycosis: A report of three cases. Mycopathol 2007;164(1):35-8. DOI: 10.1007/s11046-007-9022-y.         [ Links ]

3. Kontoyiannis DP, Lewis RE. Invasive zygomycosis: Update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006;20(3):581-607vi. DOI: 10.1016/j.idc.2006.06.003.         [ Links ]

4. Guillén Morales C, Jiménez Miramón FJ, Carrascosa Mirón T, et al. Gastritis enfisematosa con gas venoso portal: tratamiento conservador en abdomen agudo de causa infrecuente. Rev Esp Enferm Dig 2015;107(7):455-64.         [ Links ]