An Unusual Case of Abdominal Pain

CASE PRESENTATION A 50-year-old man presented to the emergency department (ED) with vomitting and epigastric pain 1 h after eating raw, wild salmon, which he had purchased from a major chain grocery store. He experienced immediate onset of profuse emesis and upper abdominal pain with no diarrhea. The epigastric pain was severe (described as 8 of 10) and persisted for 2 h. On presentation to the ED 6 h after eating the fish, he had a fever of 39°C and continued to experience severe abdominal pain, which localized to the left upper quadrant. On examination, the patient had abdominal tenderness, which was worse over the left upper quadrant and epigastrium. Hematological tests revealed a hemoglobin level of 167 g/L, a platelet count of 96×109/L and an elevated white blood cell count of 11.4×109/L, with predominant neutrophilia but no eosinophilia. His chest x-ray was unremarkable, and stool culture for ova and parasites was negative. An abdominal x-ray revealed an abnormal contour of air surrounding the gastric mucosa, suggesting extensive lobular thickening. A subsequent computed tomography scan revealed uniform thickening of the ruggae in the fundus and body of the stomach, suggestive of acute gastritis or neoplasia. He underwent esophagogastroduodenoscopy (EGD), at which time a diagnosis was made.