Atypical spontaneous bacterial peritonitis linked to streptococcal toxic shock syndrome

Anamnesis and clinical examination A 59-year-old female patient with an unremarkable medical history presented with watery diarrhea, severe lower abdominal pain, and fever for approximately 7 days. Physical examination revealed a distended abdomen, bowel sounds were absent, and there was an acute abdomen with generalized guarding and significantly elevated inflammatory markers. Diagnosis Abdominal computed tomography showed significant ascites and signs of peritonitis. Exploratory diagnostics were indicated. A laparoscopy was performed, which revealed diffuse purulent peritonitis. Organ perforation or other reasons for a peritonitis were excluded. Therapy and clinical course Bacteriological examination and blood cultures showed beta-hemolytic group A streptococci, leading to the diagnosis of spontaneous bacterial peritonitis caused by streptococci. The patient was treated with antibiotics, progressively recovered, and was discharged symptom-free and without sequelae. Conclusion Primary spontaneous bacterial peritonitis caused by Streptococcus pyogenes is a rare cause of acute abdomen. An early diagnosis and immediate antibiotic therapy are crucial for prognosis.