Abstract
Fulminant Streptococcus pyogenes infection (FSPI) presents with a wide range of severe manifestations and is associated with a high mortality. However, pelvic inflammatory disease (PID) has not been reported previously as an initial presentation of FSPI. Herein, we report a case of FSPI who presented with PID as the initial manifestation. A-58-year-old woman was diagnosed as having PID by a physician and transferred to our hospital. The laboratory findings at the first presentation to our hospital revealed evidence of severe infection (WBC 18,800/μL, CRP 51.5mg/dL) and acute renal failure. The only significant finding on CT was a small volume of ascites. Exploratory laparotomy revealed severe inflammation of the pelvic organs. In light of the laparotomy findings and the exacerbated sepsis state, we suspected FSPI, and performed retroperitoneal evacuation and initiated the patient on continuous hemodiafiltration. However, the patient deteriorated, developed multiple organ failure, and died 43 hours after hospitalization. Subsequently, Streptococcus pyogenes was cultured from the vagina and retroperitoneum. This case emphasizes the need for clinicians to be aware of severe PID as a possible initial manifestation of FSPI, which carries an unfavorable prognosis.
