S3589 Lymphocytic Gastritis: A Rare Form of Chronic Gastritis

Abstract

INTRODUCTION: Lymphocytic gastritis (LG) is a form of chronic gastritis characterized by intraepithelial lymphocytes in the mucosa of the antrum or fundus. LG is considered a rare entity, presenting in <5% of gastric biopsies. (1) Little is known about the presentation, clinical significance, and evolution of disease. Current literature suggests a possible association between LG, Helicobacter pylori, and also Celiac disease. CASE DESCRIPTION/METHODS: A 58-year-old female with a past medical history of GERD, diverticulitis, and obesity presented to the Emergency Department with a 3 day history of sudden onset localized right upper quadrant abdominal pain. It was constant and sharp . Review of systems was positive for nausea and non-bilious emesis. On exam, the patient was comfortable and not ill appearing. Abdomen was soft, non-distended with normoactive bowel sounds. Palpation revealed mild tenderness of the epigastrium and right upper quadrant without rebound tenderness and guarding. Laboratory studies were normal and included: WBC, transaminases, total bilirubin, alkaline phosphatase, and lipase. An abdominal x ray showed no evidence of bowel obstruction or free intraperitoneal air. A CT abdomen with contrast showed a small focus of eccentric wall thickening near the mid sigmoid colon, concerning for possible neoplasm. The patient was treated with IV Zofran, Pepcid (discharged on this medication), and normal saline which resolved the abdominal pain. Due to CT abnormalities, the gastroenterology team was consulted, and the patient was scheduled for an outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. EGD was normal, however, random gastric biopsies obtained for H. pylori from the gastric body, antrum, and incisura revealed increased CD3+ intraepithelial T cells consistent with LG. H.pylori immunohistochemical stain was negative. Colonoscopy (intubating the terminal ileum) revealed moderate sigmoid colon diverticulosis and internal hemorrhoids without colonic masses or ulcerations. She was continued on omeprazole and remains asymptomatic. DISCUSSION: Knowledge of LG remains limited. Due to a possible association between LG and Celiac disease a celiac serology panel and repeat EGD with duodenal biopsies will be obtained. This case serves to highlight a relatively new entity, its presentation, and possible associations.