Suppurative gastritis in a HIV-positive patient: A case report

Abstract

Introduction. Suppurative gastritis (SG) is a rare disease characterized by a bacterial infection of the stomach wall. This condition has high mortality rate, especially in patients with predisposing factors such as alcoholism, immunodeficiency and previous endoscopic gastric procedures. Case report. A 41 year old male was hospitalized with epigastric pain, fever and vomiting. The symptoms started a few days after esophagogastroduodenoscopy (EGD). His personal medical history included periodical excessive alcohol consumption. Based on initial blood tests the patient was diagnosed with sepsis and was promptly started a treatment with antibiotics. In the first few days of hospitalization there was an improvement in inflammation marker levels, but the patient was still febrile and with the referred epigastric pain. A computed tomography scan showed marked thickening of the gastric wall and EGD revealed deep ulcers in the stomach with fibrinopurulent exudate. Histological examination of gastric biopsies showed necrosis and abscesses. Blood cultures were positive for Stenotrophomonas maltophilia and Pseudomonas aeruginosa with subsequent change in antibiotics. The repeated blood tests showed leucopenia and the patient tested positive for human immunodeficiency virus (HIV). A second EGD showed pus in the stomach, with a gastric aspirate culture positive for Enterococcus spp. The treatment was modified and a third EGD showed healed gastric mucosa confirmed by histopathological evaluation. Conclusion. Taking in consideration the high mortality rate of SG, it is necessary to make an early diagnosis and start the treatment against specific pathogens, since it can be crucial for a better outcome of this clinical condition.