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VOLUME 25 , ISSUE 10 ( October, 2021 ) > List of Articles


Phlegmonous Gastritis and Streptoccocal Toxic Shock Syndrome: An Almost Lethal Combination

Elisabeth Paramythiotou, Mitrakou Cornelia, Savva Athinna, Antoniadou Anastasia, Armaganidis Apostolos, Dimopoulos George

Keywords : Multiorgan failure, Phlegmonous gastritis, Septic shock, Streptococcus group A

Citation Information : Paramythiotou E, Cornelia M, Athinna S, Anastasia A, Apostolos A, George D. Phlegmonous Gastritis and Streptoccocal Toxic Shock Syndrome: An Almost Lethal Combination. Indian J Crit Care Med 2021; 25 (10):1195-1198.

DOI: 10.5005/jp-journals-10071-23997

License: CC BY-NC 4.0

Published Online: 30-09-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


We report a case of phlegmonous gastritis in a 70-year-old woman without any predisposing factors, presenting with high fever, epigastric pain, and vomiting complicated by septic shock and multiorgan failure. The ultrasound and the computed tomography scan showed thickening of the stomach wall. Streptococcus pyogenes was isolated in the blood, thereby establishing the diagnosis of streptococcal toxic shock syndrome. An exploratory laparotomy excluded the need for a gastrectomy, and the patient was successfully treated with antibiotics. A short review of phlegmonous gastritis caused by S. pyogenes during the last 12 years is also presented.

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  1. Yang H, Yan Z, Chen J, Xie H, Wang H, Wang Q. Diagnosis and treatment of acute phlegmonous gastritis: a case report. Medicine (Baltimore) 2018;97(18):e0629. DOI: 10.1097/MD.0000000000010629.
  2. O'Toole PA, Morris JA. Acute phlegmonous gastritis. Postgrad Med J 1988;64(750):315–316. DOI: 10.1136/pgmj.64.750.315.
  3. Kobus C, van den Broek JJ, Richir MC. Acute gastric necrosis caused by a β-hemolytic streptococcus infection: a case report and review of the literature. Acta Chir Belg 2020;120(1):53–56. DOI: 10.1080/00015458.2018.1500799.
  4. Yokota T, Yamaki T, Yashima R, Yamada Y, Narushima Y, Kikuchi S, et al. Emergency operation for phlegmonous gastritis. Ups J Med Sci 2005;110(3):237–240. DOI: 10.3109/2000-1967-069.
  5. Kim GY, Ward J, Henessey B, Peji J, Godell C, Desta H, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc 2005;61(1):168–174. DOI: 10.1016/s0016-5107(04)02217-5.
  6. Wakayama T, Watanabe H, Ishizaki Y, Okuyama T, Ogata H, Tanigawa K, et al. A case of phlegmonous esophagitis associated with diffuse phlegmonous gastritis. Am J Gastroenterol 1994;89(5):804–806.
  7. Hu DC, McGrath KM, Jowell PS, Killenberg PG. Phlegmonous gastritis: successful treatment with antibiotics and resolution documented by EUS. Gastrointest Endosc 2000;52(6):793–795. DOI: 10.1067/mge.2000.108926.
  8. Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol 2014;20(12):3383–3387. DOI: 10.3748/wjg.v20.i12.3383.
  9. Hommel S, Savoye G, Lorenceau-Savale C, Costaglioli B, Baron F, Le Pessot F, et al. Phlegmonous gastritis in a 32-week pregnant woman managed by conservative surgical treatment and antibiotics. Dig Dis Sci 2007;52(4):1042–1046. DOI: 10.1007/s10620-006-9235-9.
  10. Lee BS, Kim SM, Seong JK, Kim SH, Jeong HY, Lee HY, et al. Phlegmonous gastritis after endoscopic mucosal resection. Endoscopy 2005;37(5):490–493. DOI: 10.1055/s-2005-861254.
  11. Iqbal M, Saleem R, Ahmed S, Jani P, Alvarez S, Tun HW. Successful antimicrobial treatment of phlegmonous gastritis: a case report and literature review. Case Rep Hematol 2018;2018:8274732. DOI: 10.1155/2018/8274732.
  12. Mittleman RE, Suarez RV. Phlegmonous gastritis associated with the acquired immunodeficiency syndrome/pre-acquired immunodeficiency syndrome. Arch Pathol Lab Med 1985;109(8): 765–767. PMID: 3839379.
  13. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 2000;13(3):470–511. DOI: 10.1128/cmr.13.3.470-511.2000.
  14. Kan-no Y1, Irisawa A, Takagi T, Shibukawa G, Wakatsuki T, Suzuki E, et al. Endosonographic diagnosis and follow-up of phlegmonous gastritis. J Clin Ultrasound 2007;35(9):524–526. DOI: 10.1002/jcu.20333.
  15. Harikumar R, Pramod K, Pushpa M, Simi K, Arun G. Gastric lymphoma presenting as phlegmonous gastritis. J Gastrointest Cancer 2007;38(1):24–27. DOI: 10.1007/s12029-008-9011-5.
  16. Paik DC, Larson JD, Johnson SA, Sahm K, Shweiki E, Fulda GJ. Phlegmonous gastritis and group A streptococcal toxic shock syndrome in a patient following functional endoscopic sinus surgery. Surg Infect (Larchmt) 2010;11(6):545–549. DOI: 10.1089/sur.2009.064.
  17. Sahnan K, Davis BJ, Bagenal J, Cullen S, Appleton S. Acute gastric necrosis after routine oesophagogastroduodenoscopy with therapeutic argon plasma coagulation. Ann R Coll Surg Engl 2013;95(6):e99–e101. DOI: 10.1308/003588413X13629960047515.
  18. Rada-Palomino A, Muñoz-Duyos A, Pérez-Romero N, Vargas-Pierola H, Puértolas-Rico N, Ruiz-Campos L, et al. Phlegmonous gastritis: a rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. Rev Esp Enferm Dig 2014;106(6):418–424. PMID: 25361454.
  19. Morimoto M, Tamura S, Hayakawa T, Yamanishi H, Nakamoto C, Nakamoto H, et al. Phlegmonous gastritis associated with group A streptococcal toxic shock syndrome. Intern Med 2014;53(22): 2639–2642. DOI: 10.2169/internalmedicine.53.2741.
  20. Ramphal W, Mus M, Nuytinck HKS, van Heerde MJ, Verduin CM, Gobardhan PD. Sepsis caused by acute phlegmonous gastritis based on a group A Streptococcus. J Surg Case Rep 2018;2018(8):rjy188. DOI: 10.1093/jscr/rjy188.
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