Two cases of phlegmonous esophagogastritis

초록

Phlegmonous esophagogastritis is a rare bacterial infection has been reported to have some mortality rate. The pathophysiology of this disease is unclear, but some predisposing factors are reported such as immunocompromised status, alcohol abusing, uncontrolled diabetes mellitus. Because the standard of treatment for phlegmonous esophagogastritis is still not well established, identification of pathogen with proper antibiotics and surgical drainage are effective treatments for phlegmonous esophagogastritis. We reported two cases of phlegmonous esophagogastritis with newly diagnosed diabetes mellitus. A 26-year-old and a 56-year-old women visited hospital for sore throat, neck pain and fever. The laboratory findings of both patients demonstrated leukocytosis, elevated C-reactive protein and blood glucose level. Their HbA1c was above 11%. Chest computed tomography of both women showed submucosal edema with intramural abscess in stomach and esophagus, and paraesophageal abscess with severe inflammation in mediastinum, respectively. In both cases, we initially started empirical antibiotic therapy including 3rd cephalosporin and metronidazole. Later, we identified Klebsiella pneumonia via pus culture in both cases. A 26-year-old woman improved symptoms with conservative management with antibiotics, however 56-year-old woman underwent surgical drainage and esophagectomy. We suggest that early radiologic diagnosis of CT and the accurate identification of pathogens via esophagoduodenoscopy or surgical approach is an important key factors of the prognosis of the disease.