Primary Streptococcal Peritonitis Treated Conservatively—A Case Report—

Abstract

A 39-year-old woman visited our hospital with abdominal pain, fever, and diarrhea. Physical examination showed signs of peritoneal irritation, and laboratory findings indicated systemic inflammation, leading to a diagnosis of acute generalized peritonitis. Computed tomography indicated no signs of gastrointestinal perforation or intestinal ischemia to explain the patient's symptoms, and primary peritonitis was suspected. She received intensive care with circulatory and respiratory management, broad-spectrum antibiotics, catecholamines, continuous hemodiafiltration, and endotoxin adsorption therapy. Blood culture performed on day 4 revealed Group A Streptococcus pyogenes, and we diagnosed primary peritonitis secondary to streptococcal toxic shock syndrome. The aforementioned conservative treatment was continued, and she was closely monitored while we contemplated surgical treatment. Systemic symptoms subsequently improved, and the patient was discharged on day 23. Primary peritonitis secondary to Streptococcal toxic shock syndrome is rare, and in most cases, laparotomy is performed for drainage. Few reports have described life-saving conservative treatment in such patients. We report a case of primary streptococcal peritonitis that responded to conservative treatment.