J Korean Diabetes.  2015 Jun;16(2):153-159. 10.4093/jkd.2015.16.2.153.

Two Cases of Phlegmonous Esophagogastritis in New Onset Type 2 Diabetes

• Yoon JW
• Kim CW
• Kim MJ
• Kwon HY
• Kim SI
• Lee SN
• Hong S
• Lee KH
• Han JY
• Kim SH
• Nam M
• Kim YS

• KMID: 2137275
• DOI: http://doi.org/10.4093/jkd.2015.16.2.153

Abstract

Phlegmonous esophagogastritis is a rare bacterial infection that has been reported to result in mortality. The pathophysiology of phlegmonous gastrointestinal infection is unclear, but some predisposing factors are reported. Those include immunocompromised status, alcohol abuse, malignancy and uncontrolled diabetes mellitus. We report two cases of phlegmonous esophagogastritis with newly diagnosed diabetes mellitus. A 26-year-old woman and a 56-year-old woman individually visited our hospital for sore throat, neck pain and fever. The laboratory findings of both patients demonstrated leukocytosis, and elevated serum glucose levels. HbA1c of both patients was above 11%. Enhanced computed tomography of young woman showed submucosal edema with intramural abscess along the esophagus and stomach, and that of older woman showed the same defined to esophagus. In both cases, empirical antibiotic therapy with intravenous third generation cephalosporin and metronidazole were started. Later, we identified Klebsiella pneumonia through pus culture in both cases. The symptoms of case 1 improved with conservative management with antibiotics only. However, case 2 required surgical drainage and esophagectomy. Early radiologic diagnosis of this disease and accurate identification of pathogens are important factors for good prognosis. Therefore, we emphasize suspicion of such a rare disease is needed, especially when the patient has risk factors such as diabetes mellitus.

Keyword

Diabetes mellitus; Esophagogastritis; Phlegmonous infection

MeSH Terms

Abscess
Adult
Alcoholism
Anti-Bacterial Agents
Bacterial Infections
Blood Glucose
Causality
Cellulitis*
Diabetes Mellitus
Diagnosis
Drainage
Edema
Esophagectomy
Esophagus
Female
Fever
Humans
Klebsiella
Leukocytosis
Metronidazole
Middle Aged
Mortality
Neck Pain
Pharyngitis
Pneumonia
Prognosis
Rare Diseases
Risk Factors
Stomach
Suppuration
Anti-Bacterial Agents
Metronidazole

Figure

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  Fig. 1. Abdomen computed tomography shows concentric wall thickening with intramural low attenuation of lower esophagus (A) and entire stomach (B).

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  Fig. 2. Duodenogastroscopy demonstrated diffuse hypertrophic mucosal change (B) with pus discharge (A).

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  Fig. 3. Follow up abdomen computed tomography shows improved low attenuated wall thickening of esophagus (A) and stomach (B).

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  Fig. 4. Neck computed tomography shows eccentric intramural abscess with wall thickening of cervical esophagus.

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  Fig. 5. (A) Esophagogram obtained on the 10th hospital day reveals contrast leakage at left anterolateral aspect of upper esophagus. (B) Follow up esophagogram obtaianed on the 47th hospital day shows remaining stricture at upper esophageal operation site.

Reference

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