Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3 1Indiana University Southwest, Evansville, IN; 2Indiana University Southwest, Cedar Rapids, IA; 3Good Samaritan Hospital, Vincennes, IN
Introduction: Acute necrotizing gastritis (ANG) is a rare, rapidly progressing gastrointestinal (GI) condition characterized by widespread mucosal necrosis and high mortality. The etiological spectrum of ANG includes infections, ischemic events, and toxin exposures. This case report presents a unique instance of ANG caused by Group A β-hemolytic streptococcus (GABHS) with eventual mortality. It emphasizes the clinical rarity and the critical need for early diagnosis and intervention.
Case Description/Methods: A 57-year-old woman with a history of controlled diabetes mellitus and hypertension presented to the emergency department with acute epigastric pain, nausea, and vomiting. Physical examination revealed diffuse abdominal tenderness with guarding. Initial laboratory tests showed leukocytosis (WBC: 24,000/μL) and elevated C-reactive protein (CRP: 35 mg/L). Abdominal computed tomography (CT) demonstrated significant gastric wall thickening and intramural air, indicative of ANG.
Urgent upper endoscopy revealed extensive necrosis and ulcerations throughout the gastric mucosa (Image 1). Biopsy specimens and aspirates were obtained for microbiological analysis. Gram staining and subsequent cultures confirmed the presence of GABHS. Broad-spectrum intravenous antibiotics, including piperacillin-tazobactam and clindamycin, were promptly initiated.
Despite aggressive medical management and supportive care, the patient's condition deteriorated, developing septic shock and multi-organ failure. Despite intensive care support, including vasopressors and renal replacement therapy, the patient succumbed to the illness on the third day of hospitalization.
Discussion: The rapid progression and high mortality associated with ANG necessitate a high index of suspicion and swift diagnostic and therapeutic measures. GABHS, a common pathogen in pharyngitis and soft tissue infections, is an uncommon cause of GI infections, making this case particularly notable.
Prompt endoscopic evaluation and microbiological testing, appropriate antimicrobial therapy and multidisciplinary supportive care, are essential for accurate diagnosis and effective management. In this case, early identification of GABHS allowed for targeted antibiotic therapy, though the patient’s condition progressed too rapidly for recovery. This case also suggests the need for further research into early diagnostic markers and treatment protocols to improve outcomes in ANG patients.
Figure: Image 1: Necrosis and ulceration of the gastric mucosa.
Disclosures:
Muhammad Chaudhary indicated no relevant financial relationships.
Muhammad Ismail indicated no relevant financial relationships.
Oluwagbenga Serrano: MERCK – Stock-publicly held company(excluding mutual/index funds).
Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3. P5117 - Acute Necrotizing Gastritis Due to Group A β-hemolytic Streptococcus: A Rare and Fatal Case, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
