A case of phlegmonous gastritis requiring differentiation from gastric syphilis

Abstract

A 33-year-old man presented to our hospital with the chief complaint of epigastric pain. Abdominal CT revealed localized wall thickening in the gastric antrum. In the same area, upper gastrointestinal endoscopy revealed multiple shallow ulcers fused into a geographical pattern. Based on the endoscopic findings and the patient’s social history (history of sexual activity with many and unspecified persons) , gastric syphilis was initially suspected. However, a serological test for syphilis turned out negative, and immunostaining of a tissue sample from the lesion demonstrated the absence of treponema. In a culture of a gastric mucosal tissue specimen, Streptococcus viridans was detected, which led to the diagnosis of phlegmonous gastritis. He started receiving conservative treatment with antibiotics (AMPC) and recovered. Patients with acute abdomen should be diagnosed and treated with care in consideration of phlegmonous gastritis or gastric syphilis as differential diagnosis.