bStreptomyces organisms are soil inhabitants rarely causing nonmycetomic infections. We describe a case of secondary peritonitis caused by Streptomyces viridis in a chronic alcoholic patient who presented with fever, abdominal distension, and pain in the abdomen. The most likely source of infection was by inoculation through multiple paracenteses, done for treatment of ascites, before the patient came to our health care center. This is the second case report of Streptomyces peritonitis and the first case caused by Streptomyces viridis, which is usually found in the soil in our geographic region.
CASE REPORTA 53-year-old male presented to the medical emergency room with complaints of fever, abdominal distension, and pain in the abdomen for 7 days. He was a chronic alcoholic, taking around 214 g of alcohol daily for the past 10 years. There was no history of melaena or hematemesis. There was also no history of any headache, rhinorrhea, sore throat, cough, dysuria, or bowel complaints. The patient gave a history of multiple paracenteses, done outside our hospital, for management of abdominal distension.On examination, the patient was febrile (38°C) and was in mild distress due to dyspnea and abdominal pain. His sclerae of both sides were icteric. On palpation, his abdomen was firm, distended, and diffusely tender. The rest of the systemic examination was within normal limits.On admission, the peripheral leukocyte count was 17,000/ mm 3 , with 84% neutrophils and 12% lymphocytes. The platelet count was adequate. The serum creatinine level was 1.5 mg/dl, and the sodium level was 135 mmol/liter. The total bilirubin level was elevated, at 4.4 mg/dl, as were the alanine aminotransferase and aspartate transaminase levels (93 and 105 U/liter, respectively) and the international normalized ratio (1.1). The test for HIV was nonreactive. Upper gastrointestinal (GI) endoscopy revealed grade II esophageal varices, and ultrasonography of the abdomen showed signs of chronic liver disease with gross ascites. To rule out any infectious cause, specimens of blood and ascitic fluid were submitted for culture before the patient was started on ceftriaxone.Ascitic fluid collected was pale yellow and turbid in appearance. It showed a white blood cell count of 5,600/mm 3 , with a differential count of 80% neutrophils and 20% lymphocytes. Gram staining showed the presence of pus cells with long, filamentous, extensively branched, Gram-positive structures. Aerobic culture on blood agar showed a significant number of large, folded, glabrous colonies with an earthy odor. Gram staining from blood agar showed Gram-positive, branching, filamentous bacilli. Partial acid-fast staining was negative. Based on culture characteristics, Gram staining, and acid-fast staining, the isolate was presumptively identified as belonging to a Streptomyces species and was sent to