Sarcina ventriculi associated gastritis: a rare finding in dyspepsia

A 35-year-old woman presented with upper abdominal pain for last one month. The pain was dull, non-radiating, and located in the epigastric region without any radiation or referral. Pain was associated with loss of appetite and unintentional weight loss of 3 kilograms over the past month; but was not associated with jaundice, awareness of lump, hematemesis, melena or hematochezia. Physical and laboratory examination was unremarkable. For further evaluation of pain and unintentional weight loss, an upper gastrointestinal endoscopy was done which showed erythematous mucosa of the gastric antrum (Figure 1A). Histopathological examination of the erythematous gastric mucosa showed presence of basophilic, cuboid-shaped packets, arranged in tetrads, approximately the size of red blood cells, consistent with Sarcina ventriculi (Figure 1B and 1C). The organisms were identified on H&E and were present in the foveolar mucus. No evidence of Helicobacter pylori infection was noted. The patient was treated with combination of oral pantoprazole, with metronidazole and ciprofloxacin for 7 days. On follow-up the patient showed signs of improvement, with resolution of pain and weight stabilization. Repeat endoscopy after a month was normal.