Phlegmonous Gastritis Refractory to Antibiotics with Subsequent Improvement on Empiric Quadruple Therapy

Phlegmonous gastritis is a rare infection of the gastric wall that presents with nonspecific symptoms and can rapidly progress with high mortality. We report a 59-year-old woman with two days of intractable nausea, vomiting, and inability to tolerate oral intake while on chronic proton-pump inhibitor therapy. She had leukocytosis, diffuse gastric wall thickening on computed tomography, and severe gastric mucosal abnormalities with antral sparing on endoscopy. Biopsy showed acute purulent gastritis but was negative for Helicobacter pylori. Given the unclear etiology and incomplete response to initial broad-spectrum antibiotics, empiric H. pylori quadruple therapy was initiated. The patient subsequently demonstrated clinical improvement without requiring surgical intervention.