Primary Peritonitis Secondary to Streptococcus pyogenes in a Young Female Adult—A Case Report and Literature Review

Abstract

Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as Streptococcus pyogenes) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis. A diagnostic laparoscopy confirmed primary peritonitis with an unknown infection source and causative pathology, as the appendix, ovaries and bowels were healthy-looking. Fluid cultures returned positive for GAS Pyogenes, while blood and urine cultures were negative. The discussion reviews the challenges in diagnosis and treatment of GAS primary peritonitis, highlighting the need for clinical suspicion, early diagnosis via laparoscopy or laparotomy and prompt antibiotic therapy as the current standard for treatment.

Peritonitis caused by group A streptococcus: A case report and literature review

“…According to the PRISMA 2020 statement [3] , 56 reports including 65 cases were found to be eligible ( Fig. 3 ) [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] . As shown in Fig.…”

Oral Sex following Abortion: Case Report of a Sexually Transmitted Infection of Group A Streptococcus Causing Peritonitis

“…Peritonitis usually occurs from an abdominal source such as appendicitis, diverticulitis, or hollow viscus perforation. Pri-mary peritonitis is an infective inflammation of the peritoneal cavity in the absence of an abdominal source [1][2][3][4]. Primary peritonitis represents less than 1% of all peritonitis [5,6].…”

“…Primary peritonitis represents less than 1% of all peritonitis [5,6]. Considering that most primary peritonitis occurs in association with chronic hepatopathy or nephropathy, autoimmune disease, and immunosuppression, spontaneous peritonitis without predisposing factors therefore remains very unusual [1]. Streptococcus pneumoniae represents the first cause of spontaneous peritonitis [17] while GAS remains very rare [7].…”

“…Peritonitis primarily occurs in the absence of an abdominal source [1][2][3][4] and represents less than 1% of all peritonitis in adults [5,6]. Streptococcus pyogenes (Group A Streptococcus; GAS) disease is unique to humans and can range from mild infections of pharyngitis and scarlet fever, to severe invasive manifestations such as bacteremia, cellulitis, necrotizing fasciitis, streptococcal toxic shock syndrome, septic arthritis, puerperal sepsis, meningitis, osteomyelitis, and endocarditis [1,2,[7][8][9][10]. However, it is an unusual pathogen involved in peritonitis [11].…”

“…There is now more evidence that GAS peritonitis, although very rare, is associated with vaginal delivery [1,4,9,15], gynecologic interventions [1,11], and intrauterine contraceptive devices (IUCD) [1,4,16]. Orogenital contact is a well-known means of transmission of disease but only one case of transmission has been previously reported through oral sex [16].…”