A 64-year-old man with decompensated liver cirrhosis secondary to nonalcoholic steatohepatitis presented to the emergency room with chief complaints of hematemesis. The patient had a medical history of hemodialysis due to diabetic nephropathy. Computed tomography revealed diffuse gastric wall thickness, and upper endoscopy showed fibrinopurulent exudates lining the stomach and superficial ulcerations. From imaging studies, we suspected phlegmonous gastritis and immediately administered vancomycin and piperacillin/tazobactam. Staphylococcus epidermidis was grown in a culture of gastric juice and tissue specimen. Based on these studies, phlegmonous gastritis was diagnosed.
Follow-up endoscopy revealed a remarkable recovery of the gastric mucosa. After 2 weeks of antibiotics treatment, the patient's condition improved.
Phlegmonous gastritis is a rare bacterial infection that poses diagnostic and therapeutic challenges. Early diagnosis and treatment will lead to improved outcomes, without the need for a surgical intervention.
