Rare cause of acute abdomen: group A streptococcus peritonitis

This report describes a previously healthy woman who presented with sepsis. Initial evaluation suggested an intra-abdominal or genitourinary source. An exploratory laparotomy was performed, revealing significant purulence in the lower right quadrant and pelvis without an obvious source of infection. Peripheral and peritoneal cultures revealed group A streptococcus (GAS), a rare cause of primary peritonitis. The patient had no acute history of upper respiratory infections. The pathogenesis and portal of entry for GAS peritonitis remain unclear, but recent research has identified oral sex practices as a conduit for infection. Prompt recognition and treatment are paramount to avoid mortality. This case report adds to the growing body of knowledge on unusual, life-threatening causes of acute abdominal pain. Previous cases, as well as this one, demonstrate successful treatment of infection with antibiotics. The symptoms of primary peritonitis mimic several other common gastrointestinal and genitourinary afflictions. A few reported cases describe a common presentation of acute-onset abdominal pain, fever, nausea and vomiting. Surgical intervention may be difficult to avoid, but a strong index of suspicion for GAS peritonitis when other obvious sources of infection have not been confirmed can potentially expedite non-invasive antibiotic therapy and replace unnecessary exploratory surgery.2 Although GAS peritonitis is a rare manifestation of GAS sepsis, the increasing global incidence and severity of such infections suggest that such presentations may become more common, and vigilance in diagnosis will be necessary to avoid mortality.1 © BMJ Publishing Group Limited 2024.