Necrotizing gastritis as a rare complication in a pediatric patient with acute lymphoid leukemia

Abstract

Necrotizing gastritis is an infrequent entity with unknown prevalence, the diagnosis is often inci-dental during exploratory laparotomy or autopsies of patients with acute abdomen. Objective: To present a clinical case of necrotizing gastritis, a rare entity that should be taken into account in the context of immunocompromised patients with associated risk factors. Clinical Case: 7-year-old male schoolboy diagnosed with T-precursor acute lymphoid leukemia, finishing induction chemotherapy cycle with PETHEMA 2013 protocol. He presented 12 days of symptoms characterized by epigas-tric abdominal pain and vomiting, initially acute pancreatitis was suspected, ruled out by normapancreatic enzymes and abdominal computed tomography. Due to suspicion of acid peptic disease associated with steroids, treatment with proton pump inhibitors and prokinetics was started. Consi-dering dyspepsia with alarm signs, such as progression of neutropenia, increased C-reactive protein and clinical deterioration, esophagogastroduodenoscopy (EGD) was performed, compatible with necrotizing gastritis, confirmed by histopathology. He received pharmacological management, zero regimen and parenteral support, and progressive improvement was evidenced in imaging controlsAfter fasting for 30 days, enteral nutrition was started, well tolerated, with ambulatory follow-upAfter improvement, chemotherapy plan was completed, highlighting complete remission, withoucomplications after 2 years. Conclusion: Necrotizing gastritis is a rare entity, in the case described the risk factors were immunocompromise, previous management with corticosteroids and cytotoxic therapy, and possibly, exposure to stressful situations during hospitalization. Early diagnosis and treatment determined a favourable prognosis.