title: Streptococcal Toxic Shock Syndrome: Life Saving Role of Peritoneal Lavage and Drainage.
abstract: OBJECTIVE
  We encountered a case where an infection with group A streptococcus (GAS; ie, Streptococcus pyogenes) initially caused primary peritonitis and then subsequently caused streptococcal toxic shock syndrome. The patient's life was likely saved by an emergency laparotomy followed by extensive peritoneal lavage and drainage.
  
  
  METHODS
  A 40-year-old woman was admitted to the Emergency Department for lower abdominal pain and numbness in the extremities. She presented with systemic inflammatory response syndrome. An emergency laparotomy was performed, and ascites that resembled pus and general peritonitis were noted. Peritoneal lavage and drainage were performed, and GAS was isolated from peritoneal fluid. Gram staining of cervical polyp specimens revealed Gram-positive bacteria.
  
  
  CONCLUSIONS
  The patient was diagnosed with streptococcal toxic shock syndrome due to an ascending GAS infection originating from vagina.
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Minako
authors: M
authors: Yokoyama
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Fumie
authors: F
authors: Oyama
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Asami
authors: A
authors: Ito
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Megumi
authors: M
authors: Yokota
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Daisuke
authors: D
authors: Matsukura
authors: Department of Surgery, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Shinji
authors: S
authors: Tsutsumi
authors: Comprehensive Medical Care Unit, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Tomonori
authors: T
authors: Kasai
authors: Department of Orthopedics, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Yohshiro
authors: Y
authors: Nitobe
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Akiko
authors: A
authors: Morikawa
authors: Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan.
authors: Takashi
authors: T
authors: Ozaki
authors: Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
authors: Yoshihito
authors: Y
authors: Yokoyama
keywords: ascending infection; emergency laparotomy; group A streptococcus; peritoneal lavage and drainage; streptococcal toxic shock syndrome