Sarcina Ventriculi infection: a rare but fearsome event. A Systematic Review of the Literature

Bloodstream infection caused by sarcina ventriculi:Case report

Sarcina ventriculi is a gram-positive anaerobic coccus that commonly associated with various gastrointestinal diseases. Here, we report a complete case of bloodstream infection caused by Sarcina ventriculi for the first time. A 60-year-old male patient diagnosed with sigmoid colon adenocarcinoma who had undergone multiple chemotherapy and radiotherapy. The patient underwent blood culture sampling due to fever and the pathogen identified as Sarcina ventriculi through 16S rRNA sequencing analysis. Sarcina ventriculi has a unique arrangement and cell wall structure, which can easily be mistaken for a fungus. This case reveals the difficulties in the diagnosis and treatment of Sarcina ventriculi infection. It can be served as a reference for clinicians and microbiologists faced with similar diagnostic and treatment challenges in the future. Meanwhile, we call for increased attention to Sarcina ventriculi which may also be the late complication of gastrointestinal malignancies.

Intestinal microbiota profiles of captive-bred cynomolgus macaques reveal influence of biogeography and age

BACKGROUND

Age-associated changes to the intestinal microbiome may be linked to inflammageing and the development of age-related chronic diseases. Cynomolgus macaques, a common animal model in biomedical research, have strong genetic physiological similarities to humans and may serve as beneficial models for the effect of age on the human microbiome. However, age-associated changes to their intestinal microbiome have previously only been investigated in faecal samples. Here, we have characterised and investigated the effects of age in the cynomolgus macaque intestinal tract in luminal samples from both the small and large intestine.

RESULTS

Whole metagenomic shotgun sequencing was used to analyse the microbial communities in intestinal content obtained from six different intestinal regions, covering the duodenum to distal colon, of 24 healthy, captive-bred cynomolgus macaques, ranging in age from 4 to 20 years. Both reference-based and assembly-based computational profiling approaches were used to analyse changes to intestinal microbiota composition and metabolic potential associated with intestinal biogeography and age. Reference-based computational profiling revealed a significant and progressive increase in both species richness and evenness along the intestinal tract. The microbial community composition also significantly differed between the small intestine, caecum, and colon. Notably, no significant changes in the taxonomic abundance of individual taxa with age were found except when sex was included as a covariate. Additionally, using an assembly-based computational profiling approach, 156 putative novel bacterial and archaeal species were identified.

CONCLUSIONS

We observed limited effects of age on the composition of the luminal microbiota in the profiled regions of the intestinal tract except when sex was included as a covariate. The enteric microbial communities of the small and the large intestine were, however, distinct, highlighting the limitations of frequently used faecal microbial profiling as a proxy for the intestinal microbiota. The identification of a number of putative novel microbial taxa contributes to knowledge of the full diversity of the cynomolgus macaque intestinal microbiome.

Evaluation of extended-spectrum β-lactamase producing bacteria in feces of shelter dogs as a biomarker for altered gut microbial taxa and functional profiles

Background

The USA is home to 83-88 million dogs, with 3-7 million living in shelters. Shelter dogs move through the supply chain from their geographical origin to adoptive homes, with possible exposure to pathogens and shift in their gut microbiota. However, research in this area is limited. This study examined the effects of intestinal colonization by ESBL bacteria on gut taxa abundance, diversity, and functions in 52 shelter dogs of various ages, sexes, and fertility statuses.

Methodology

We isolated fecal DNA, sequenced their 16S, processed the sequences using DADA2, identified taxa profiles in each dog by Phyloseq, and analyzed Chao1, Shannon, and Simpson alpha diversity by ggplot2 and Wilcoxon test. We analyzed beta diversity using Bray-Curtis dissimilarity matrix from the vegan package. Differential abundance of taxa, gut microbiome functions, and differential abundance of microbiome functions were analyzed using DESeq2, PICRUSt2, and ALDEx2, respectively, with Wilcoxon rank and Kruskal-Wallis tests for comparisons between dog groups.

Results

Firmicutes (69.3%), Bacteroidota (13.5%), Actinobacteriota (6.77%), Proteobacteria (5.54%), and Fusobacteriota (4.75%) were the major phyla in the gut of shelter dogs. ESBL bacteria colonized dogs had reduced gut microbiota alpha diversity than non-colonized dogs. The abundance levels of the following phyla (Proteobacteria, Deferribacterota, Bacteroidota, Fusobacteriota, and Spirochaetota), class (Gammaproteobacteria, Bacteroidia, Deferribacteres, Brachyspirae, and Fusobacteria), and families (Enterobacteriaceae, Peptostreptococcaceae, Lactobacillaceae, Lachnospiraceae, Prevotellaceae, and Peptostreptococcaceae) were significantly (p < 0.05) varied between the two dog groups. Further stratified analysis by age, sex, and spaying/neutering status influenced the abundance of taxa in ESBL bacteria colonized dogs, indicating these covariates act as effect modifiers. Most gut metabolic and biosynthetic pathways were downregulated in ESBL bacteria colonized dogs compared to non-colonized dogs. However, alpha-linolenic acid metabolism and shigellosis, fluorobenzoate degradation, allantoin degradation, toluene degradation, glycol degradation, fatty acid and beta-oxidation, and glyoxylate metabolism bypass pathways were increased in dogs colonized by ESBL bacteria.

Conclusion

Colonization by ESBL bacteria marks altered gut microbiota. Dog's demography and fertility status modify the alterations, indicating host factors and ESBL bacteria interplay to shape gut microbiota. ESBL bacteria or other factors reprogram gut microbiome functions through down and upregulating multiple metabolic and biosynthesis pathways to promote ESBL bacteria colonization.

Association of Gastric Sarcina With Malignant Pyloric Stenosis

Sarcina ventriculi (SV) is a Gram-positive cocci that thrives in the acidic stomach environment and may cause gastrointestinal symptoms. A 65-year-old woman with a history of Helicobacter pylori gastritis and diabetes presented with abdominal pain, vomiting, diarrhea, and weight loss. Initial esophagogastroduodenoscopy revealed pyloric stenosis with thickened prepyloric gastric folds, and endoscopic biopsy revealed SV without malignancy. Owing to persistent symptoms, endoscopic ultrasound was done with repeat biopsies and was nondiagnostic. Subsequently, a robotic gastrojejunostomy was done due to persistent gastric outlet obstruction symptoms. Surgical specimens revealed signet ring cell carcinoma. This case highlights the importance of suspecting underlying malignancy in patients with SV and the necessity of comprehensive diagnostic evaluation when endoscopic findings are inconclusive.

The Spectrum of Sarcina Colonization in the Gastrointestinal Tract of Pediatric and Adolescent Patients

INTRODUCTION

Sarcina organisms are rare, gram-positive, sugar-fermenting cocci, identifiable in tissues only by histologic examination or molecular testing. Since its discovery, the pathogenicity and relevance of Sarcina in the human gastrointestinal tract has remained ill-defined. A recent literature review of 66 reported examples demonstrated the potential for severe complications such as emphysematous gastritis and gastric perforation. In pediatrics, colonization is associated with mucosal alterations and/or gastrointestinal dysmotility/obstruction with variable outcomes, including death secondary to gastric perforation. Yet, the features of Sarcina colonization within the gastrointestinal tract of adolescents are poorly understood and rarely reported.

METHODS

We present the gastrointestinal histopathological findings and the complete history of 4 pediatric patients with Sarcina colonization at our institution. Additionally a literature review with focus in the keywords "Sarcina" and "gastrointestinal' was performed, and the clinical and histopathological features of all previously reported examples of Sarcina in the gastrointestinal tract of pediatric patients were summarized.

RESULTS

All 4 patients had delayed gastric emptying, 3 of them due to neurologic disease, and one with pyloric obstruction due to duodenal ulceration with Helicobacter gastritis. In the 3 patients with available esophageal biopsies, it was associated to esophagitis with increased intraepithelial eosinophils.

CONCLUSION

The potential pathogenicity of Sarcina colonization in the gastrointestinal tract of pediatric patients needs to be reevaluated. Due to potential serious complications, the identification of these organisms in the gastrointestinal tract sample should be reported and warrants further evaluation for possible gastrointestinal dysmotility or other mucosal alterations.

Gastric Mucosa Infection Caused by Sarcina Associated With Ulceration and Upper Gastrointestinal Bleeding

Sarcina sp. (Ss) infection is a rare cause of gastrointestinal disease, with only 66 cases reported worldwide. We present a case of a 56-year-old man with alcohol abuse, smoking, and chronic obstructive pulmonary disease who presented with upper gastrointestinal bleeding and decompensated cirrhosis. Endoscopy and biopsy revealed gastric ulcers with tetrad-shaped cocci consistent with Ss. After 32 days of hospitalization and broad-spectrum antibiotic therapy, both clinical and endoscopic improvement was observed. This case highlights the atypical presentation of this increasingly recognized infection and the importance of prompt diagnosis and supportive care.

Sarcina ventriculi Bacteremia Complicating Aspiration Pneumonia: A Case Report

Sarcina ventriculi, a large anaerobic Gram-positive coccus that clusters in tetrads, is most commonly detected histologically in gastric biopsy specimens from patients with gastrointestinal disorders. Herein, we describe a rare case of bacteremia caused by S. ventriculi in an 89-year-old man. The patient had a history of cerebral infarction, atrophic gastritis, and chronic obstructive pulmonary disease and was receiving home oxygen therapy. He was admitted to our hospital with a right femoral neck fracture. Three days after femoral surgery, he developed aspiration pneumonia, and S. ventriculi was detected in the anaerobic blood culture bottle. A Gram-stained sputum smear showed large Gram-positive cocci (presumed to be S. ventriculi) clustered in tetrads. The patient was diagnosed with S. ventriculi bacteremia as a complication of aspiration pneumonia and recovered after ceftriaxone treatment. A literature review revealed only three previous case reports of S. ventriculi bacteremia. In previous case reports, the gastrointestinal tract was the presumed portal of entry into the blood. To our knowledge, S. ventriculi bacteremia has not previously been reported as a complication of lower respiratory tract infection.

Unusual Presentation: Chronic Gastritis Caused by Sarcina ventriculi Identified via Helicobacter pylori Immunohistochemistry

This case report presents a rare occurrence of Sarcina ventriculi in a 15-year-old male patient with a clinical history of renal failure due to chronic rejection status post kidney transplantation, with persistent symptoms of diarrhea, nausea, vomiting, and fatigue. Despite exhibiting normal gastrointestinal mucosa upon endoscopy, biopsy analysis revealed chronic gastritis accompanied by the presence of Sarcina ventriculi in a tetrad arrangement across the stomach, duodenum, and distal esophagus. Interestingly, immunohistochemistry (IHC) staining targeting the Helicobacter pylori organism (H. pylori) also highlighted the presence of Sarcina ventriculi, suggesting a potential cross-reactivity between the two pathogens. Further investigation into the protein sequences and three-dimensional structures of H. pylori and Sarcina ventriculi revealed significant similarities, with a 65% protein sequence alignment and nearly identical configurations in the urease subunit. This finding suggests the possibility of cross-reactivity in diagnostic testing, particularly in IHC staining for H. pylori. This case highlights the importance of clinical awareness regarding Sarcina infections, particularly in symptomatic patients with seemingly normal endoscopic findings. The potential for cross-reactivity in IHC staining for H. pylori may offer valuable insights into the detection of Sarcina ventriculi, underscoring the significance of thorough diagnostic evaluation in such cases.

Microbial composition of gastric lesions: differences based on Helicobacter pylori virulence profile

Helicobacter pylori infection is a major risk factor for gastric adenocarcinomas. In the case of the intestinal subtype, chronic gastritis and intestinal metaplasia are well-known sequential steps in carcinogenesis. H. pylori has high genetic diversity that can modulate virulence and pathogenicity in the human host as a cag Pathogenicity Island (cagPAI). However, bacterial gene combinations do not always explain the clinical presentation of the disease, indicating that other factors associated with H. pylori may play a role in the development of gastric disease. In this context, we characterized the microbial composition of patients with chronic gastritis (inactive and active), intestinal metaplasia, and gastric cancer as well as their potential association with H. pylori. To this end, 16 S rRNA metagenomic analysis was performed on gastric mucosa samples from patients with different types of lesions and normal gastric tissues. Our main finding was that H. pylori virulence status can contribute to significant differences in the constitution of the gastric microbiota between the sequential steps of the carcinogenesis cascade. Differential microbiota was observed in inactive and active gastritis dependent of the H. pylori presence and status (p = 0.000575). Pseudomonades, the most abundant order in the gastritis, was associated the presence of non-virulent H. pylori in the active gastritis. Notably, there are indicator genera according to H. pylori status that are poorly associated with diseases and provide additional evidence that the microbiota, in addition to H. pylori, is relevant to gastric carcinogenesis.

Gastric bezoars secondary to mixed infection with Sarcina ventriculi and G + bacilli: a case report

Sarcina ventriculi is a bacterium with a specific histological morphology and infection can present with symptoms such as abdominal pain, nausea, vomiting and occasionally fatal complications. Delayed gastric emptying is regarded as the most significant risk factor for infection. Its pathogenicity is currently unknown and treatment options are inconsistent. Here we report a case of gastric bezoars secondary to a mixed infection of Sarcina ventriculi and G + bacilli, which is diagnosed by a pathological biopsy.

A pilot case-control study on the fecal microbiota of pediatric functional abdominal pain-not otherwise specified and the role of early life stress

Background: Gut microbial features and the role of early life stress in pediatric functional abdominal pain-not otherwise specified (FAP-NOS) have never been investigated before. Here, we hypothesize that early life stress is more prevalent in FAP-NOS compared to healthy controls and that fecal microbial profiles and related metabolites differ between groups. Methods: In an international multicenter case-control study, FAP-NOS patients (n = 40) were compared to healthy controls (n = 55). Stool samples and demographic and clinical data including early life traumatic events and antibiotics treatments were collected from children aged four to twelve years. Fecal microbial profiles were assessed with 16S rRNA gene amplicon sequencing. Microbial metabolite concentrations in fecal supernatant, including short-chain fatty acids and amino acids, were detected via liquid chromatography. Results: Microbial richness was increased in FAP-NOS compared to healthy controls and microbial composition (unweighted UniFrac) differed between groups. Three distinct amplicon sequencing variants and two distinct species were enriched in FAP-NOS compared to controls, with no observed changes at higher taxonomic levels. No differences in microbial metabolites and early life stress were observed between groups. Conclusion: The presented hypothesis could not be proven, with no observed differences in occurrence of early life stress, and fecal microbial metabolic profiles between pediatric FAP-NOS and healthy controls. Pediatric FAP-NOS patients exhibited mild differences in the fecal microbial community compared with controls. Further large-scale studies with high-resolution techniques are warranted to address the biological relevance of present observations.

Epidemiology of rare bacterial, parasitic, and fungal pathogens in India

Rare human pathogens are infrequently observed clinically but can lead to undiagnosed infections, delays in treatment, severe complications, including death. Traditional diagnostic tools cannot routinely detect rare infections in public health settings. This study focuses on the incidence and outcomes of rare pathogenic microorganisms over 13 years (2010-2022) using PubMed database to obtain epidemiological data on rare bacterial, parasitic, and fungal infections in hospitals throughout India. A total of 974 articles were screened using case studies, datasets, comments, classical articles, letters, editorials, observational studies, and meta-analyses. Our analysis identified 28 rare bacteria, six parasites, and five fungal species infections in India. Fatal cases were associated with rare bacterial and fungal infections, including two from pan-drug-resistant bacteria (both from the Myroides genus). A total of 10 bacterial species displayed multi-drug resistance; one was extensively drug-resistant, and eight remained unclassified. Of the 83 patients with these rare infections, the mortality was ∼8.4% (seven of 83). Considering drug resistance and high mortality, prompt diagnosis of rare pathogens is crucial to controlling their spread. An increased awareness within the Indian health care system focusing on diagnostics, record keeping, and data sharing will be necessary to enhance surveillance.

Case report and mini-review: Sarcina ventriculi in the stomach of an 80-year-old female

Sarcina ventriculi, also known as Zymosarcina ventriculi and, incorrectly, as Clostridium ventriculi, is rarely encountered in clinical settings. A patient with a complicated gastrointestinal (GI) history, who was acutely presenting with small-bowel obstruction, was found to be colonized by S. ventriculi. The distinctive morphology of this species, with large Gram-variable cocci (up to 3 µm) arranged in two-by-two cuboid clusters reaching up to 20 µm, was key in identifying this bacterium in a stomach biopsy specimen. Sarcina ventriculi appears to be ubiquitously found in nature, and related bacterial species can cause GI-related disease in various animals. Clinical manifestations in humans are broad and often related to other underlying comorbidities. Isolation of S. ventriculi in the laboratory requires anaerobic culture on select media but its absence from standard MALDI-TOF databases complicates identification. Susceptibility data do not exist, so empiric treatment is the only option for this rare pathogen.

Clostridium ventriculi in a cynomolgus monkey with acute gastric dilatation and rupture: A case report

Acute gastric dilatation (AGD) is one of the most prevalent and life-threatening diseases in nonhuman primates worldwide. However, the etiology of this syndrome has not been determined. Recently, sudden death occurred in a 7-year-old female cynomolgus monkey with a history of fecal microbiota transplantation using diarrheic stools. The monkey had undergone surgery previously. On necropsy, gastric dilatation and rupture demonstrated a tetrad arrangement on histopathologic examination. On 16S rRNA sequencing, a high population of Clostridium ventriculi was identified in the duodenum adjacent to stomach but not in the colon. This paper is the first report of Clostridium ventriculi infection in a cynomolgus macaque with acute gastric dilatation and rupture.

Recent Records on Bacterial Opportunistic Infections via the Dietary Route

This narrative review was aimed at identifying the opportunistic bacterial pathogens that can be transmitted by contaminated food and represent a current threat for patients particularly susceptible to infections because of underlying conditions or predisposing factors. The analysis was focused on recent case or outbreak reports and systematic reviews published in the years 2019 to 2023 and resulted in sorting 24 bacterial groups comprising the genera or species able to cause a variety of systemic or invasive infections if ingested with food or drinking water. These included both bacteria known to cause mild infections in immunocompetent persons and bacteria considered to be innocuous, which are used in food fermentation or as probiotics. No recent cases of infections transmitted through dietary routes were reported for the critical nosocomial pathogens widely found in food products, primarily Acinetobacter baumannii and Klebsiella pneumoniae. However, the very first sources of their introduction into the clinical environment still need to be established. In many instances, risky dietary habits, such as eating raw fish, seafood, raw meat, unpasteurized milk, and their derived products or the lack of control in fermentation processes, has led to the reported illnesses, pointing out the necessity to improve the hygiene of production and consumer awareness of the risks.

Sarcina sp. as a presumptive cause of fatal acute gastric dilation and gastric emphysema in rhesus macaques

A 4-y-old female and 3-y-old male rhesus macaque (Macaca mulatta), both housed in the same facility, died unexpectedly within 2 wk. Postmortem examination revealed severe gastric dilation in both macaques and gastric emphysema in the female macaque. Histologically, bacteria consistent with Sarcina sp. were present in both macaques within the lungs and lumen of the trachea, esophagus, and gastrointestinal (GI) tract without associated inflammation. Additionally, in the female macaque, the bacteria were found in the gastric mucosa and associated with emphysematous spaces in the gastric wall without associated inflammation. PCR and Sanger sequencing of amplicons were subsequently performed on GI contents and non-alimentary tissues from the 2 affected monkeys and on comparative samples from unaffected rhesus monkeys in the same facility and an adjacent primate facility. The cases were compared using the 2-tailed Fisher exact test (p-value at 95% confidence). PCR identified Sarcina in GI contents of both affected and unaffected monkeys (p = 0.6084) and in non-alimentary tissues of affected monkeys only (p = 0.0083). These results suggest that the presence of Sarcina sp. in non-alimentary tissues is associated with gastric distension, gas accumulation, and unexpected death in nonhuman primates.

Gastroenteric-anastomosis in the setting of marked stomach dilatation associated with gastric pyloric obstruction secondary to Sarcina ventriculi

Sarcina ventriculi is an anaerobic gram-positive bacterium capable of surviving in the acidic environment of the stomach and causing gastrointestinal symptoms. We report the case of a 51-year-old patient with no notable medical history who presented with abdominal distension, nausea, and vomiting. Initial endoscopic evaluation revealed a distended stomach in stasis with pyloric stenosis. Biopsies revealed the presence of Helicobacter pylori and S. ventriculi. A therapeutic protocol was administered, but no symptomatic relief was observed. Subsequently, the patient was referred to our institution, where computed tomography imaging of the abdomen was performed. The results corroborated a presentation suggestive of a high obstruction attributable to a right anterior para-duodenal internal hernia. Ultimately, surgery was undertaken, ruling out the diagnosis of right para-duodenal internal hernia and resulting in gastroenteric anastomosis with satisfactory improvement in clinical symptoms.

Unveiling the Culprit: Sarcina Infection in the Stomach and Its Link to Unexplained Weight Loss

Sarcina species (spp.) infections in humans are relatively rare; however, reported cases have recently increased. We have presented the case of a 56-year-old female with diabetes who presented with bloating, dysphagia, and substantial weight loss, ultimately diagnosed with reactive gastritis secondary to Sarcina spp. infection. Administration of antibiotics and a proton pump inhibitor led to symptom alleviation and weight gain. This case underscores the significance of considering Sarcina spp. infection in patients experiencing unexplained weight loss and nonspecific gastrointestinal symptoms, highlighting the importance of promptly identifying and managing these infections to prevent potentially life-threatening complications that are becoming more prevalent in literature.

Species and Strain Variability among Sarcina Isolates from Diverse Mammalian Hosts

Sarcina spp. has been isolated from the gastrointestinal tracts of diverse mammalian hosts. Their presence is often associated with host health complications, as is evident from many previously published medical case reports. However, only a handful of studies have made proper identification. Most other identifications were solely based on typical Sarcina-like morphology without genotyping. Therefore, the aim of this work was culture detection and the taxonomic classification of Sarcina isolates originating from different mammalian hosts. Sarcina-like colonies were isolated and collected during cultivation analyses of animal fecal samples (n = 197) from primates, dogs, calves of domestic cattle, elephants, and rhinoceroses. The study was carried out on apparently healthy animals kept in zoos or by breeders in the Czech Republic and Slovakia. Selected isolates were identified and compared using 16S rRNA gene sequencing and multi-locus sequence analysis (MLSA; Iles, pheT, pyrG, rplB, rplC, and rpsC). The results indicate the taxonomic variability of Sarcina isolates. S. ventriculi appears to be a common gut microorganism in various captive primates. In contrast, a random occurrence was also recorded in dogs. However, dog isolate N13/4e could represent the next potential novel Sarcina taxonomic unit. Also, a potentially novel Sarcina species was found in elephants, with occurrences in all tested hosts. S. maxima isolates were detected rarely, only in rhinoceroses. Although Sarcina bacteria are often linked to lethal diseases, our results indicate that Sarcina spp. appear to be a common member of the gut microbiota and seem to be an opportunistic pathogen. Further characterization and pathogenic analyses are required.

[3 cases of abomasitis in calves associated with Sarcina sp. infection]

In this case report - to the best knowledge of the authors for the first time in the German-speaking region - 3 calves with ulcerating or emphysematous abomasitis respectively are presented, in which intralesional bacteria of the Sarcina species were identified. The unusual appearance of these bacteria is described, their etiopathogenic relevance discussed.

Distal Gastrectomy With Roux-en-Y Reconstruction for a Seriously Dilated Stomach With Gastric Outlet Obstruction Secondary to Sarcina ventriculi: A Case Report

Sarcina ventriculi is an anaerobic gram-positive coccus that can resist the acidic media of the stomach and cause gastrointestinal symptoms. Here, we report the case of a 43-year-old male patient with a history of schizophrenia presenting with abdominal distention, nausea, vomiting, early satiety, and weight loss. Computed tomography of the abdomen and pelvis with contrast revealed a severely dilated stomach and signs of gastric outlet obstruction on multiple occasions. The endoscopic evaluation showed a dilated stomach, and biopsies revealed non-specific gastritis, negative Helicobacter pylori, and positive S. ventriculi with metaplasia. Medical treatment with proton pump inhibitors, pro-kinetics, ciprofloxacin, and metronidazole failed to improve his symptoms. Finally, the patient was managed surgically with distal gastrectomy with Roux en Y reconstruction, and gastrostomy tube placement was done with satisfactory improvement in his symptoms.

A Rare Case of Erosive Esophagitis Due to Sarcina Ventriculi Infection

Sarcina ventriculi is a Gram-positive anaerobic coccus found in soil that is a rare cause of inflammatory infections of the GI tract. This bacterium has a propensity for causing gastritis in patients with delayed gastric emptying. Of the 66 reported cases in the literature, 10 involved the esophagus. Symptoms of an esophageal infection are non-specific and may be mistaken for long-standing gastroesophageal reflux. We present a case of a 67-year-old female with chronic dysphagia and reflux diagnosed with erosive esophagitis caused by Sarcina ventriculi. Treatment strategies documented in the literature are reviewed.