PG patients typically present with acute abdominal pain, vomiting and fever. But although this symptom triad is considered characteristic of PG [4], retrospective studies have shown that considerable shares of patients don't experience any complaints besides an acute abdomen. In detail, epigastric pain has been reported in 95% of cases, whereas nausea, vomiting and fever are described by two thirds of affected individuals only [1]. A certain relief of pain may be achieved by changing from a supine to a sitting position (Deininger's sign) [5], and fever may be accompanied by chills. Patients less commonly present hematemesis or coffee-ground emesis [6]. Moreover, purulent emesis has been reported and is considered pathognomonic for PG [7].

Upon perforation, patients deteriorate rapidly and develop signs of diffuse peritonitis, sepsis and multiple organ failure [8]. There is one case report describing the discharge of pus to liver and spleen, giving rise to multiple hepatic and splenic abscesses [9].

• Fever

  A 63-year-old woman was admitted with high fever. Laboratory tests showed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal ultrasonography and computed tomography revealed multiple liver and splenic tumors. [ncbi.nlm.nih.gov]

  On day 10, the patient developed neutropenic fever, and the white blood count (WBC) noted to be 0.1   109/L with absolute neutrophil count (ANC) of 0. [hindawi.com]

• Hypoventilation

  "acute phlegmonous gastritis"怎么读 相关词汇 phlegmonous appendicitis 中文, chronic superficial antral gastritis 中文, acute acute 中文, acute mumps 中文, acute hypoventilation 中文, acute abdomen 中文, acute bronchiolitis 中文, acute gonorrhea 中文, acute dyspnes 中文, acute [ichacha.net]

• Vomiting

  A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. [ncbi.nlm.nih.gov]

  M 66 None Epigastric pain, nausea, vomiting Klebsiella, Acinetobacter CT, EGD with biopsy Antibiotics Nil Discharge Liu YJ, 2013 M 84 Colon cancer, prostate cancer Fever, nausea, vomiting Polymicrobial (gram positive and gram negative organisms) CT, [hindawi.com]

  Four days prior, the patient complained of severe epigastric pain with high fever (highest temperature was 39.2 C) and vomited. [journals.lww.com]

• Nausea

  A 77-year-old man with diabetes and a gastric ulcer was urgently admitted due to prolonged nausea and vomiting. Computed tomography revealed widespread diffuse thickening of the gastric wall, and PG was suspected. [ncbi.nlm.nih.gov]

  Antibiotics, gastrectomy Nil Discharge Matsumoto H, 2015 M 74 Myelofibrosis, multiple myeloma, neutropenia Epigastric pain, nausea Bacillus spp. [hindawi.com]

  It usually presents with upper gastrointestinal symptoms, such as nausea, vomiting, and hematemesis, along with systemic symptoms, including fever, chills, and fatigue. [cureus.com]

  We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. [pesquisa.bvsalud.org]

• Epigastric Pain

  Phlegmonous gastritis is an acute inflammatory process of the stomach clinically characterized by acute localized noncolicky epigastric pain, purulent vomiting, fever, and leukocytosis. [ncbi.nlm.nih.gov]

  […] gastric biopsy Antibiotics, gastrectomy Nil Discharge Matsumoto H, 2015 M 74 Myelofibrosis, multiple myeloma, neutropenia Epigastric pain, nausea Bacillus spp. [hindawi.com]

  We had experienced a case of 66-year-old man presented with epigastric pain, nausea, vomiting, and hematemesis, followed by aspiration pneumonia. [pesquisa.bvsalud.org]

  It presents with epigastric pain and vomiting. Other symptoms include fevers, chills, diarrhea, and hematemesis [4]. The diagnosis can be made using abdominal ultrasound, CT scan, endoscopy, and endoscopic ultrasound. [cureus.com]

• Gastropathy

  Gastropathy Chemical (reactive) gastropathy Chemical gastropathy was recommended as the preferred term to synonyms such as chemical gastritis, type C gastritis and reactive gastropathy, and refers to endoscopic and histological changes caused by chemical [cmej.org.za]

  Gastropathy-NSAID-related 소염제유발위염 Gastric antral vascular ectasia 위전정부 혈관 확장증. The image above is from an antral biopsy from a 9 year old boy. What additional histological finding is most likely to be present in this patient? A. [amve.preblechildrenscenter.org]

  Emphysematous Gastritis Clinical Case Conference Ranjeeta Bahirwani August 25, ppt download Imaging of Abnormal Air in the Abdomen and Pelvis 20 Emphysematous Gastritis Radiopedia Pictures and Ideas on Meta Digestive System - Emphysema Gastritis and Gastropathies [e.hes.fr]

  Reactive gastropathy is the second most common diagnosis made on gastric biopsy specimens after H pylori gastritis. This entity is believed to be secondary to bile reflux and was originally reported after partial gastrectomy (Billroth I or II). [emedicine.medscape.com]

• Loss of Appetite

  Depends on the etiology (see below). asymptomatic epigastric pain/tenderness nausea and vomiting loss of appetite Etiology infection: H. pylori (most common) systemic illness: trauma and burns pharmacological/medication: NSAIDS autoimmune caustic ingestion [radiopaedia.org]

  The most common symptoms of acute gastritis include abdominal bloating, belching, loss of appetite, vomiting, nausea and nondescript epigastric discomfort. Some cases of acute gastritis may also be accompanied by painful sensations in the abdomen. [ic.steadyhealth.com]

  There may be systemic signs of infection, such as fever, general fatigue, chills, sweating, headache, loss of appetite. Cause [ edit ] Commonly caused by bacterial infection, as in the case of cellulitis or diverticulitis. [en.wikipedia.org]

  Loss of appetite; increased thirst; Lethargy ; Prolonged vomiting; Severe diarrhea; Orange urine and an increased frequency of urination; Behavioral change such as what is the cure for cold sores natural remedies. gastritis drug therapy cider vinegar [ict-accordance.eu]

  Common symptoms of gastritis: pain in the upper abdomen, fasting and / or after a meal, heaviness in the stomach after a meal, nausea, vomiting, regurgitation, weight loss, loss of appetite. [medicforums.blogspot.com]

Laboratory analyses of blood samples should be conducted to assess the patient's general condition and typically yield the following results [5]:

• Moderate to severe leukocytosis
• Increased erythrocyte sedimentation rate
• Elevation of C-reactive protein
• Unaltered levels of amylase and lipase (contrary to patients suffering from acute pancreatitis)

Such results are non-specific, though, and it is necessary to perform diagnostic imaging in order to correlate the clinical picture with severe gastritis. Endoscopy is very helpful to this end, but computed tomography scans may also be carried out. During an endoscopic examination, multiple lesions of the gastric mucosa may be observed. In general, they are largely covered by mucopurulent exudate and are prone to bleed. Generalized edema and erythema are also seen. Endosonography may allow for a better examination of deeper layers of the gastric wall. In this context, hypoechoic lesions in the submucosal layer have been described [1]. Images obtained by means of computed tomography typically show marked thickening of the gastric wall and intramural hypodense regions [10].

• Pericardial Effusion

  effusions were also suggested. [wjgnet.com]

• Air Bronchogram

  bronchograms of the left lung, pleural and pericardial effusions were also suggested. [wjgnet.com]

• Human Herpesvirus 8

  Kaposi sarcoma is a low-grade vascular neoplasm associated with human herpesvirus 8, also known as the KS-associated herpesvirus. There are 4 epidemiologic types of KS. [archivesofpathology.org]

• Gastric Lesion

  Endoscopic submucosal dissection (ESD) is widely used to treat a variety of gastric lesions including early gastric cancer and gastric adenoma. Bleeding and perforation are the most common complications of ESD. [dbpia.co.kr]

Phlegmonous gastritis (PG), sometimes also referred to as suppurative gastritis, is a rare type of stomach infection and inflammation. It is provoked by pyogenic bacteria, most commonly by pathogens of the genus Streptococcus [1], and is associated with high mortality [2]. It has been speculated that patients with a medical history of recurrent gastritis, those suffering from chronic ulcer that may or may not be the result of drug abuse, as well as immunocompromised individuals are at higher risks of developing PG [3], but the disease' pathophysiology remains poorly understood. About half of PG patients have no medical history of stomach disease. PG may be restricted to determined parts of the stomach lining, or may affect the whole stomach. Accordingly, localized and diffuse PG may be distinguished. Successful treatment regimens comprise the administration of antibiotics and surgery. Because survival rates are similar in either case, most patients are initially prescribed antibiotics and surgical interventions are postponed for refractory cases and complications [2]. If necessary, partial or complete gastrectomy may be performed.

1. Kim GY, Ward J, Henessey B, et al. Phlegmonous gastritis: case report and review. Gastrointest Endosc. 2005; 61(1):168-174.
2. Rada-Palomino A, Muñoz-Duyos A, Pérez-Romero N, et al. Phlegmonous gastritis: A rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review. Rev Esp Enferm Dig. 2014; 106(6):418-424.
3. Kavalar R, Skok P, Kramberger KG. Phlegmonous gastritis in a patient with rheumatoid arthritis. Wien Klin Wochenschr. 2005; 117(9-10):364-368.
4. Orel R, Mlinaric V, Stepec S, Luzar B, Brencic E, Cerar A. Acute phlegmonous gastritis associated with Helicobacter heilmannii infection in a child. Dig Dis Sci. 2006; 51(12):2322-2325.
5. Alonso JV, de la Fuente Carillo JJ, Gutierrez Solis MA, Vara Morate FJ, Lopez Ruiz DJ. Gastric wall abscess presenting as thoracic pain: rare presentation of an old disease. Ann Gastroenterol. 2013; 26(4):360-362.
6. Jaballah S, Sabri Y, Yacoubi MT, Mustapha K. Phlegmonous gastritis complicated by upper digestive hemorrhage. Dig Dis Sci. 1999; 44(12):2435-2438.
7. Nicholson BW, Maull KI, Scher LA. Phlegmonous gastritis: clinical presentation and surgical management. South Med J. 1980; 73(7):875-877.
8. Min SY, Kim YH, Park WS. Acute phlegmonous gastritis complicated by delayed perforation. World J Gastroenterol. 2014; 20(12):3383-3387.
9. Sakata T, Narita M, Ohtani N, et al. A case of phlegmonous gastritis with multiple liver and splenic abscesses. Nihon Shokakibyo Gakkai Zasshi. 2011; 108(1):50-58.
10. Sood BP, Kalra N, Suri S. CT features of acute phlegmonous gastritis. Clin Imaging. 2000; 24(5):287-288.