Diagnostic and therapeutic utility of gastric tissue culture in a case of phlegmonous gastritis.

Phlegmonous gastritis is a rare, potentially life-threatening bacterial infection affecting the gastric mucosa and submucosa. Clinical presentation is often non-specific, typically including symptoms such as fever, epigastric vomiting, or hematemesis. Due to its rarity and vague clinical features, diagnosis is frequently delayed, increasing the risk of severe complications such as septic shock and death. We describe the case of a 74-year-old previously healthy female who presented with vomiting, hematemesis, and epigastric pain. Endoscopy revealed diffuse erythema and purulent exudate throughout the stomach, raising suspicion for Phlegmonous gastritis. Although blood and gastric juice cultures were negative, gastric tissue culture identified Cronobacter species. Cronobacter species is an opportunistic pathogen primarily associated with severe infections in neonates, though it has also been reported in immunocompromised adults. The patient responded well to targeted antibiotic therapy and recovered without requiring surgery. This case highlights the diagnostic and therapeutic utility of gastric tissue culture in Phlegmonous gastritis, especially when conventional cultures fail to identify a pathogen. It also underscores the role of Cronobacter species as a rare but relevant pathogen in adult gastrointestinal infections such as Phlegmonous gastritis.