Fanaroff Rachel, Goldberg Eric, Papadimitriou John C, Twaddell William S, Daly Barry, Drachenberg Cinthia B
University of Maryland School of Medicine, Department of Pathology. Baltimore, MD, USA.
University of Maryland School of Medicine, Department of Medicine. Baltimore, MD, USA.
Autops Case Rep. 2020 May 6;10(2):e2020164. doi: 10.4322/acr.2020.164.
Emphysematous gastritis (EG) is a rare and potentially lethal process caused by invasive, gas-producing bacteria leading to inflammation and gas dissection of the stomach. The most common etiologic agents are Clostridium infections, but other organisms, including enterobacteria, staphylococcus, and fungi have also been identified. We report the first case of EG due to in a solid organ transplant recipient, who presented with epigastric pain and vomiting. The patient had a history of type 1 diabetes mellitus (DM) with recurrent episodes of ketoacidosis and systemic diabetic complications, including severe gastroparesis. CT scan studies demonstrated EG with venous air, and endoscopy showed severe gastritis and ulcerations. In the gastric biopsies, abundant were noted in areas of mucosal/submucosal necrosis. Antibiotic treatment was instituted at admission, and subsequent endoscopy demonstrated the disappearance of Sarcina, with some improvement of the gastric inflammation; however, the patient developed septic shock with multiorgan failure and expired. This case highlights the need to consider other infectious etiologies in transplant patients, in addition to the well-known opportunistic infections.
气肿性胃炎（EG）是一种罕见且可能致命的疾病，由侵袭性产气细菌引起，导致胃的炎症和气肿。最常见的病原体是梭菌感染，但也已鉴定出其他微生物，包括肠杆菌、葡萄球菌和真菌。我们报告了首例实体器官移植受者因[此处原文缺失相关病原体]导致的气肿性胃炎病例，该患者表现为上腹部疼痛和呕吐。患者有1型糖尿病（DM）病史，伴有反复的酮症酸中毒发作和全身性糖尿病并发症，包括严重的胃轻瘫。CT扫描显示气肿性胃炎伴有静脉积气，内镜检查显示严重胃炎和溃疡。在胃活检中，在黏膜/黏膜下坏死区域发现大量[此处原文缺失相关病原体]。入院时开始使用抗生素治疗，随后的内镜检查显示八叠球菌消失，胃炎症有所改善；然而，患者发展为感染性休克并伴有多器官功能衰竭，最终死亡。该病例强调，除了众所周知的机会性感染外，还需要考虑移植患者的其他感染病因。
