title: Primary peritonitis associated with streptococcal toxic shock-like syndrome: report of a case.
abstract: Several reports over the past 15 years describe severe group A streptococcal infections causing septic shock, soft-tissue necrosis, and multiple organ failure; a phenomenon known as streptococcal toxic shock-like syndrome (TSLS). However, primary peritonitis associated with TSLS is rare. We report the case of a 40-year-old man admitted with pain in both thighs, hypotension, and severe abdominal pain. His daughter had been diagnosed with streptococcal pharyngitis 3 days earlier. We performed an emergency laparotomy for peritonitis, and culture of the ascites was positive for group A beta -hemolytic streptococcus (GAS). Further serotyping of the isolated GAS strain revealed the T-type 22 and the pyrogenic exotoxin gene, spe-C. The criteria for TSLS were clearly met, including the isolation of GAS from ascites, hypotension, liver failure, renal failure, coagulopathy, myositis, and a generalized erythematous macular rash with desquamation.
authors.affiliation: First Department of Surgery, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Kanetake
authors.forename: Masatomo
authors.initials: M
authors.lastname: Hayashi
authors.forename: Akitsugu
authors.initials: A
authors.lastname: Hino
authors.forename: Naoki
authors.initials: N
authors.lastname: Futamura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Mori
authors.forename: Hisato
authors.initials: H
authors.lastname: Takagi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Iwata
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kumada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuo
authors.forename: Hajime
authors.initials: H
authors.lastname: Hirose
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D010538:Peritonitis / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis / Q000628:therapy*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents