PRIMARY PNEUMOCOCCAL PERITONITIS IN A HEALTHY WOMAN: CASE REPORT AND A LITERATURE REVIEW OF THE LAST 10 YEARS
Abstract
Primary peritonitis usually occurs in patients with comorbidities but very rarely can also occur in healthy patients. These rare cases have been published in increasing number and have higher incidence in women. This article refers to the case of a previously healthy 47-year-old woman who presented to the emergency room with acute abdomen, fever, and diarrhea that rapidly progressed to septic shock. She underwent exploratory laparoscopy, converted to laparotomy in attempt to exclude an intra-abdominal septic focus. Only purulent peritonitis with fibrin-purulent membranes was observed and the diagnosis of primary peritonitis was assumed. Peritoneal liquid culture revealed Streptococcus pneumoniae and then adjusted antibiotic therapy was started. There was postoperative clinical improvement. A systematic review of all PubMed published cases of primary peritonitis in healthy adults from 2008 to 2018 was performed, comparing demographic data, clinical presentation, imaging findings as well as their treatment and respective outcome.
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References
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19. Iwata Y, Iwase S. Group A Streptococcal Peritonitis and Toxic Shock Syndrome in a Postmenopausal Woman. Intern Med. 2017;56(18):2523-2527. doi:10.2169/internalmedicine.8552-16
20. Iitaka D, Ochi F, Nakashima S, Fujiyama J, Masuyama M. Treatment with antibodies against primary group A streptococcal peritonitis. Med (United States). 2017;96(52). doi:10.1097/MD.0000000000009498
21. Varela ML, Mogildea M, Moreno I, Nunez D. From the pharynx to the abdomen: A case of primary peritonitis. Acta Med Port. 2018;31(12):774-777. doi:10.20344/amp.10053
22. Solomkin JS. Evaluating Evidence and Grading Recommendations: The SIS/IDSA Guidelines for the Treatment of Complicated Intra-Abdominal Infections. Surg Infect (Larchmt). 2010;11(3):269-274. doi:10.1089/sur.2010.020
2. Cortese, F., Fransvea, P., Saputelli, A. et al. Streptococcus pneumoniae primary peritonitis mimicking acute appendicitis in an immunocompetent patient: a case report and review of the literature. J Med Case Reports 13, 126 (2019).https://doi.org/10.1186/s13256-019-2038-3
3. Malota M, Felbinger TW, Ruppert R, Nüssler NC. Group A Streptococci: A rare and often misdiagnosed cause of spontaneous bacterial peritonitis in adults. Int J Surg Case Rep. 2015;6C:251-255. doi:10.1016/j.ijscr.2014.10.060
4. Drexel S, Tseng D. Primary Peritonitis: An Index Case of Mycoplasma hominis Infection in a Healthy Female . Case Rep Surg. 2018;2018:1-4. doi:10.1155/2018/4587801
5. Waisman DC, Tyrrell GJ, Kellner JD, Garg S, Marrie TJ, Kellner J. Original article Pneumococcal peritonitis: Still with us and likely to increase in importance. 2010;21(1):23-28.
6. Tilanus AMR, de Geus HRH, Rijnders BJA, Dwarkasing RS, van der Hoven B, Bakker J. Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: A case report and brief review of the literature. Int J Infect Dis. 2010;14(SUPPL. 3):e208-e212. doi:10.1016/j.ijid.2009.07.014
7. Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018 Dec;60:132-136. doi: 10.1016/j.ijsu.2018.10.028. Epub 2018 Oct 18. PMID: 30342279.
8. Doloy A, Godin C, Decousser JW, Panel P, Greder-Belan A, Doucet-Populaire F. Primary peritonitis due to Streptococcus pyogenes with reduced susceptibility to fluoroquinolones. Diagn Microbiol Infect Dis. 2008;62(4):447-449. doi:10.1016/j.diagmicrobio.2008.08.001
9. Elkassem, Samer; L.E.M. van L-H, A.J.E. D, B. P, D.H.T. T. Primary peritonitis in a young healthy woman: an unusual case. N Z Med J. 2008;121(1278):82-85.
10. L.E.M. van L-H, A.J.E. D, B. P, D.H.T. T. An unusual cause of a spontaneous bacterial peritonitis in a young healthy woman. N Z Med J. 2008;121(1278):82-85.
11. Thomas D, Perpoint T, Dauwalder O, et al. In vivo and in vitro detection of a superantigenic toxin Vbeta signature in two forms of streptococcal toxic shock syndrome. Eur J Clin Microbiol Infect Dis. 2009;28(6):671-676. doi:10.1007/s10096-008-0671-7
12. Monneuse O, Tissot E, Gruner L, et al. Diagnosis and treatment of spontaneous group a streptococcal peritonitis. Br J Surg. 2010;97(1):104-108. doi:10.1002/bjs.6822
13. Haap M, Haas CS, Teichmann R, Horger M, Raible A, Lamprecht G. Mystery or misery? Primary group a streptococcal peritonitis in women: Case report. Am J Crit Care. 2010;19(5):454-458. doi:10.4037/ajcc2009615
14. Legras A, LoDico R, Ferre R, Valleur P, Pautrat K. Primary peritonitis due to Streptococcus A: Laparoscopic treatment. J Visc Surg. 2011;148(4):e315-e317. doi:10.1016/j.jviscsurg.2011.07.002
15. Kaneko M, Maruta M, Shikata H, Hanayama M, Ikebe T. Acute abdomen due to group A streptococcus bacteremia caused by an isolate with a mutation in the csrS gene. J Infect Chemother. 2015;21(11):816-819. doi:10.1016/j.jiac.2015.06.010
16. Terzi HA, Demiray T, Koroglu M, et al. Intra-abdominal abscess and primary peritonitis caused by streptococcus anginosus. Jundishapur J Microbiol. 2016;9(6):29-32. doi:10.5812/jjm.33863
17. Abellán I (Department of GS and DSHULA del MSJ, Selva-Cabanero P (Departments of G and OHG de OA, Barnabé A (Department of GS and DSHULA del MSJ. Primary peritonitis by Streptococcus pyogenes. A condition as rare as it is agressive. Rev Esp Enf Dig. 2016;108(4):231-232.
18. Yokoyama M, Oyama F, Ito A, Yokota M, Matsukura D, Tsutsumi S, Kasai T, Nitobe Y, Morikawa A, Ozaki T, Yokoyama Y. Streptococcal Toxic Shock Syndrome: Life Saving Role of Peritoneal Lavage and Drainage. Clin Med Insights Case Rep. 2016 Aug 18;9:75-7. doi: 10.4137/CCRep.S40217. PMID: 27579001; PMCID: PMC4991574.
19. Iwata Y, Iwase S. Group A Streptococcal Peritonitis and Toxic Shock Syndrome in a Postmenopausal Woman. Intern Med. 2017;56(18):2523-2527. doi:10.2169/internalmedicine.8552-16
20. Iitaka D, Ochi F, Nakashima S, Fujiyama J, Masuyama M. Treatment with antibodies against primary group A streptococcal peritonitis. Med (United States). 2017;96(52). doi:10.1097/MD.0000000000009498
21. Varela ML, Mogildea M, Moreno I, Nunez D. From the pharynx to the abdomen: A case of primary peritonitis. Acta Med Port. 2018;31(12):774-777. doi:10.20344/amp.10053
22. Solomkin JS. Evaluating Evidence and Grading Recommendations: The SIS/IDSA Guidelines for the Treatment of Complicated Intra-Abdominal Infections. Surg Infect (Larchmt). 2010;11(3):269-274. doi:10.1089/sur.2010.020
Published
2021-01-20
How to Cite
FERNANDES, Sara et al.
PRIMARY PNEUMOCOCCAL PERITONITIS IN A HEALTHY WOMAN: CASE REPORT AND A LITERATURE REVIEW OF THE LAST 10 YEARS.
Revista Portuguesa de Cirurgia, [S.l.], n. 49, p. 82-87, jan. 2021.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/766>. Date accessed: 01 may 2024.
doi: https://doi.org/10.34635/rpc.766.
Section
Clinical Case
