Absceso gástrico secundario a gastritis eosinofílica. Reporte de un caso pediátrico

Introduccion:  El absceso de pared gastrica es una enfermedad poco comun, a menudo de evolucion fatal, caracterizada por infeccion bacteriana de la pared gastrica. El diagnostico es tardio en la mayoria de los casos. Se asocia frecuentemente con algun tipo de inmunocompromiso. No encontramos reportes de casos secundarios a gastritis eosinofilica. El tratamiento debe ser medico y quirurgico. El tratamiento medico solo, puede ser exitoso.  Presentacion de caso: Adolescente de 11 anos de edad, masculino, con historia de 15 dias de evolucion de caida desde 2 metros, sobre region abdominal, posteriormente presento dolor, fiebre, nauseas y vomitos. Perdida de peso importante desde el inicio del cuadro y tumoracion en epigastrio de crecimiento progresivo, FR: 24 x´ FC: 120 x´ T: 37,5oC TA 120/80 mm Hg GB: 19.900 N: 84% E: 7% L: 9% Hb: 13,6 gr/dl Hto: 40% plaquetas: 565.000 PCR: positiva Urea 26 mg/dl, creatinina 0,7 mg/dl, bilirrubina 0,13 mg/dl, FA: 485 UI/L GOT 23 UI/L GPT 22UI/L TAC de abdomen engrosamiento parietal circunferencial de toda la cavidad gastrica. Recibio cefazolina mas amikacina. Por desmejoria del cuadro se amplio a piperacilina - tazobactam + vancomicina mejorando parcialmente. Se realizo endoscopia digestiva y se realizo el diagnostico de gastritis eosinofilica. Luego del agregado de corticoides la mejoria se acelero.  Comentario : Los abscesos de pared gastrica son una patologia rara en la infancia y obliga a descartar cuadro subyacente.[abstract]  Palabras clave : [keygrp scheme=decs][ign][keyword type=m language=es]Gastritis flemonosa[ign], [keyword type=m language=es]absceso de pared gastrica[ign], [keyword type=m language=es]gastritis eosinofilica[ign], [keyword type=m language=es]pediatria[ign].[ign] ABSTRACT  [abstract language=en] Introduction:  Abscesses of the gastric wall are an uncommon condition that are often fatal and are characterized by bacterial infection of the gastric wall. Diagnosis occurs late in most cases. It is frequently associated with compromised immune systems. We did not find any reports of cases secondary to eosinophilic gastritis. Treatment must be both medical and surgical. Medical treatment alone can be successful.  Case Presentation:  Our patient was an adolescent age 11 years with 15 days progression following a 2-meter fall impacting the abdominal region who thereafter developed pain, fever, nausea, and vomiting. He had lost significant weight after initiation of symptoms along with a progressively growing epigastric tumor; respiratory rate was 24/min, HR 120; Temp. 37.5 centigrade; BP 120/80 mm Hg; WBC 19,900; N 84%; E 7%; L 9%; Hb 13.6 g/dL; HCT 40%; platelets 565,000; PCR positive; Urea 26 mg/dL; creatinine 0.7 mg/dL; bilirubin 0.13 mg/dL; ALP 485 IU/L; AST 23 IU/L; GPT 22 IU/L; abdominal CT showed circumferential wall thickening throughout the gastric cavity. He received cefazolin and amikacin. As he did not improve, this was expanded to piperacillin/tazobactam + vancomycin leading to some improvement. Digestive endoscopy was done and a diagnosis of eosinophilic gastritis was reached. After corticosteroids were added improvement accelerated.  Comments:  Gastric wall abscesses are a rare in childhood and require exclusion of any underlying condition.