Case Report

Emphysematous gastritis (EG) is a rare, life-threatening infection characterized by gas within the gastric wall caused by gas-forming organisms. Fewer than 100 cases have been reported in English literature over the past 4 decades, with mortality reaching 62%. We present a 56-year-old man with diabetes and heart failure who developed worsening nausea, vomiting, abdominal pain, and systemic infection. CT imaging revealed intramural gastric gas and air in the gastro-hepatic ligament, consistent with EG. He was treated conservatively with broad-spectrum antibiotics (piperacillin-tazobactam, later meropenem) and antifungal therapy (fluconazole), leading to clinical improvement and discharge on IV antibiotics. Differentiation from gastric emphysema is essential, as EG requires urgent antimicrobial therapy and close monitoring. Imaging findings and systemic signs are key to diagnosis. This case highlights the importance of early recognition and effective conservative management, while underscoring the need for further research to optimize antimicrobial strategies and improve outcomes.