First documented case of Sarcina in esophageal brushing cytology

A 48-year-old female with a past medical history of type 2 diabetes mellitus, diabetic enteropathy, hypertension, chronic obstructive pulmonary disease, and polysubstance abuse presented to the emergency department with chief complaints of left upper quadrant and epigastric pain as well as nausea and vomiting. She had a one week history of constipation prior to her admission. During the course of her admission her dyspepsia was investigated by upper gastrointestinal endoscopy. An endoscopic impression of esophagitis was made, and a mucosal brushing of the esophagus was performed to rule out Candida esophagitis. A Papanicolaou-stained ThinPrep cytology slide was prepared. The ThinPrep showed benign and reactive squamous epithelial cells as well as a few groups of reactive glandular cells. No features of malignancy were present. In addition, no fungal elements were identified. Of interest, a few rounded to cuboidal appearing large (2-3 μm in size) cyanophilic bacterial organisms arranged in distinctive tetrads were present. These organisms were cytomorphologically compatible with Sarcina ventriculi (Figure 1). Consultations with an expert gastrointestinal pathologist (DTP) and an expert medical microbiologist (GWP) were performed with consensus agreement and confirmation of the Sarcina diagnosis. After the presence of Sarcina organisms in the esophageal brushing ThinPrep slide was confirmed, the patient's previous pathology reports were reviewed, and a prior gastric biopsy diagnosis of Sarcina (rendered four months previously) was noted, further substantiating the cytomorphologic impression (Figure 1). The report from the prior endoscopic examination also described esophagitis and a phytobezoar. Polymerase chain reaction