A rare case of emphysematous gastritis caused by Lactobacillus fermentum in a patient with diabetes

Rev Esp Enferm Dig. 2021 May 5. doi: 10.17235/reed.2021.7951/2021. Online ahead of print.ABSTRACTA 42-year-old man with a history of type 2 diabetes mellitus (complicated by end stage renal disease on peritoneal dialysis) and chronic diarrhea was admitted to the emergency department for having an exacerbation in the number of evacuations. The patient was hypotensive and lethargic. Arterial blood gases were obtained and reported pH 7.39, PaO2 74.5 mmHg, PaCO2 34.9 mmHg, HCO3 21.1 mmol/L, lactate 1.9 mmol/L. He received intravenous fluids resuscitation and was stabilized. His physical examination was notable for somnolence and dehydration. Infectious diseases were ruled out (C. difficile toxin, bacterial and viral gastroenteritis and protozoa infestation) and the patient was transferred to inpatient ward to continue the approach of his chronic diarrhea. On his seven day of hospitalization, the patient presented intense abdominal pain irradiated to right shoulder, hypotension and delirium. Dialysis fluid analysis showed WBC count of 3200/ml (80% neutrophils); cultures were positive for Lactobacillus fermentum. An abdominal CT with intravenous contrast showed gastric wall with intramural gas and pneumoperitoneum (Fig. 1a), which prompted a total gastrectomy with esophago- jejunal anastomosis and Roux-Y loop reconstruction. Surgery found extensive gastric necrosis (Fig. 1b). He was admitted to the intensive care unit and he was started on meropenem, anidulafungin and norepinephrin...
Source: Revista Espanola de Enfermedades Digestivas - Category: Gastroenterology Authors: Source Type: research