When to think of Sarcina sp. in histopathologic examination of gastrointestinal tract: insights from a one-year-old with esophagitis and gastric outlet obstruction

Dear Editor-in-Chief,

Sarcina ventriculi is a Gram-positive, anaerobic coccus that is rarely encountered by pathologists in biopsy specimens. Despite its infrequency, its distinct histopathological characteristics facilitate the diagnosis when thoroughly investigated. In this report, we present a case of a 1-year-old patient who had a history of vomiting and diagnosed with gastric outlet obstruction via endoscopy. We emphasize the important histopathological and clinical features that should prompt pathologists to consider this organism in their differential diagnoses.

A 1-year-old girl was admitted to the emergency department due to a 10-day history of projectile vomiting, which had worsened in recent days. Upon admission, physical examination and laboratory results – including complete blood count, renal function tests, serum electrolytes, bilirubin, and amylase – were within normal limits. Mild elevations were noted in SGOT and SGPT (58 U/L and 63 U/L, respectively).

Ultrasound imaging revealed gastric expansion and delayed gastric emptying. An esophagogastroduodenoscopy (EGD) demonstrated furrowing and inflamed mucosa in the esophagus, with additional findings of inflamed gastric mucosa and gastric outlet obstruction that prevented the scope from advancing to the duodenum.

Histopathological examination of H&E-stained slides revealed acute esophagitis featuring cuboid pockets of organisms arranged in clusters of 4, 8, and more, consistent with Sarcina sp. bacteria. These organisms were also observed on the mucosal surface of the antral gastric mucosa. Notably, Helicobacter pylori was not identified in the gastric specimen (Fig. 1)