case_images: PMC10914429_01
case_images: CT scan of the abdomen without evidence of gastric wall thickening or gas in the intramural layer.
case_images: CRIGM2024-6004323.001.jpg
case_images: PMC10914429_01_CRIGM2024-6004323.001.jpg
case_images: fig1
case_images: A computed tomography (CT) scan of the abdomen was not significant for inflammatory changes or pneumatosis of the stomach (Figure 1).
case_images: Endoscopic imaging of ulcerated gastric mucosa. (a) Mucosal ulceration of the gastric fundus, (b) ulceration and severe erythema of the gastric cardia on retroflexion view, (c) ulceration and severe erythema of the gastric prepyloric and pylorus, and (d) ulceration and erosion of the greater curvature of the gastric body.
case_images: CRIGM2024-6004323.002.jpg
case_images: PMC10914429_01_CRIGM2024-6004323.002.jpg
case_images: fig2
case_images: On day 7, the patient then underwent esophagogastroduodenoscopy (EGD) which revealed severe esophagitis, nonbleeding large diffuse ulcerations involving the gastric fundus, body, antrum, and duodenum (Figure 2).
case_images: Gastric ulcer biopsy. (a) Reactive epithelium with corkscrew appearance of the surface epithelium (H & E, 100x). (b) Oxyntic mucosa with ulceration and marked reactive epithelial change (H & E, 100x). (c) Sodium polystyrene sulfonate crystals scattered in necrotic oxyntic mucosa (H & E, 100x). (d) Magnified image of sodium polystyrene sulfonate crystals with fish scale appearance (H & E, 400x).
case_images: CRIGM2024-6004323.003.jpg
case_images: PMC10914429_01_CRIGM2024-6004323.003.jpg
case_images: fig3
case_images: Gastric ulcer biopsy results showed oxyntic mucosa with ulceration, marked reactive epithelial change, necrosis, and rare refractile but nonpolarizable crystals in a fish scale pattern suggestive of SPS-induced gastritis (Figure 3).