Primary peritonitis associated with streptococcal toxic shock-like syndrome: report of a case.
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.
Kanetake
Kazuto
K
First Department of Surgery, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
Hayashi
Masatomo
M
Hino
Akitsugu
A
Futamura
Naoki
N
Mori
Yoshio
Y
Takagi
Hisato
H
Iwata
Hisashi
H
Sakamoto
Ken-ichi
K
Kumada
Yoshitaka
Y
Matsuo
Hiroshi
H
Hirose
Hajime
H
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
D000900:Anti-Bacterial Agents