Emphysematous gastritis associated with invasive gastric mucormycosis: a case report

Abstract

Emphysematous gastritis is a rare form of phlegmonous gastritis, characterized by air in the wall of the stomach due to invasion by gas-forming microorganisms. The most commonly involved microorganisms are streptococci, Escherichia coli, Pseudomonas aeruginosa, Clostrodium perfrigens and Staphylococcus aureus. Gastrointestinal mucormycosis is another rare condition, which is most frequently occurs in the stomach. Because emphysematous gastritis associated with invasive gastric mucormycosis is an extremely rare clinical condition and both are life-threatening diseases, early precise diagnosis and early treatment should be done to avoid mortality. Herein we present an extremely rare case of emphysematous gastritis associated with invasive gastric mucormycosis. A 43-yr-old man, suffering from alcoholism and diabetes, has experienced diffuse abdominal pain for 4 days. Abdominal computed tomography scan demonstrated gas within the stomach wall. A histologic examination of the total gastrectomy specimen showed several gas-filled bubbles in the wall, along with numerous fungal hyphae throughout the necrotic stomach wall. He died of multiorgan failure secondary to disseminated mucormycosis, despite the intensive medical therapy.

Fig. 1

(A) Computed tomography of the abdomen shows gastric wall thickening with a collection of dirty air bubbles (arrow), suggesting emphysematous gastritis. (B) The gross surgical specimen from the gastrectomy shows nearly total necrosis of the stomach. (C) Histologic findings of the gastrectomy specimen show some air spaces in the muscle layer of the stomach, consistent with emphysematous gastritis (H&E ×200). (D) There are numerous broad-based, nonseptate, right angular branched fungal hyphae, morphologically consistent with mucormycosis (H&E ×400).