Abstract
A 39-year-old woman was referred to our hospital from a neighboring hospital because of abdominal pain, diarrhea, and an abnormally high level of CRP after treatment for influenza A infection. There were abdominal distention and peritoneal sign. Abdominal CT scan showed massive ascites and a swollen left ovary. Exploratory laparotomy was performed with a diagnosis of general peritonitis. Large volumes of purulent ascites and a chocolate cyst of the left ovary were identified, and left adnexectomy and intraabdominal lavage and drainage were performed. After the operation, she developed systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and acute renal failure, so that continuous hemodiafiltration (CHDF) and polymyxin-B direct hemoperfusion (PMX-DHP) were started that achieved stable circulatory kinetics. Group A Streptococcus was isolated from a culture of the blood and ascites. Streptococcal toxic shock syndrome (STSS) was thus diagnosed. Antibiotic therapy mainly with penicillin was successful.
Causative factors resulting in general peritonitis in this patient are undetermined, but a possibility that the preceding infection with influenza virus might induce STSS could not be ruled out. Although STSS associated with peritonitis is rare, early surgical drainage and multimodal treatment are essential.
