Phlegmonous Gastritis and Group A Streptococcal Toxic Shock Syndrome in a Patient following Functional Endoscopic Sinus Surgery

TL;DR: This is an unusual case presentation of a rare but potentially lethal condition, whose optimal treatment is unclear, that should be considered when isolated gastric wall thickening is encountered in the clinical setting of toxic shock syndrome.

Abstract: Background: Phlegmonous gastritis is a rare and often fatal condition that can affect healthy individuals in 50% of cases. The condition has been described in accounts dating back to the pre-antibiotic era, during which time mortality was nearly 100%. Over the past century, case reports average about one per year. The etiology remains unclear, although Streptococcus species is isolated frequently. The optimum treatment has not been delineated clearly but likely involves a combination of antibiotics with or without surgical resection. Methods: A case report was presented and the pertinent literature was reviewed. Case Report: A 45-year-old man with a history of recent paranasal sinus surgery presented with acute abdominal pain and criteria consistent with toxic shock syndrome. Computed tomography scan showed diffuse thickening of the gastric wall and free intraperitoneal fluid. Exploratory laparotomy revealed a thickened stomach wall with outer fibrinous exudate and murky peritoneal fluid, which g...