Streptococcus Pyogenes Primary Peritonitis: A paediatric Case Report

Author(s): Arad Khodarahmi, Rahdakrishnan Nair

Introduction: Primary peritonitis is an uncommon condition in the paediatric population, typically caused by Gram-negative organisms, but very rarely caused by Gram-positive organisms, such as in this case of a 15-year-old female with Streptococcus pyogenes primary peritonitis. This rare condition poses a significant diagnostic challenge for surgeons reviewing such patients.

Case Presentation: This case report details a 15-year-old, previously healthy female presenting with abdominal pain, fever, and gastrointestinal symptoms. Patient vitals and significantly raised inflammatory markers raised concerns for sepsis. Empirical intravenous (IV) broad-spectrum antibiotics were promptly initiated. Same-day diagnostic laparoscopy revealed four-quadrant purulent peritonitis with no apparent source, and cultures were obtained. Postoperatively, the patient was treated with a targeted antibiotic regimen based on culture results, identifying S. pyogenes as the causative organism. The patient demonstrated marked clinical improvement and was discharged with oral antibiotics. Followup confirmed resolution of symptoms and normalisation of inflammatory markers.

Discussion: This case underscores diagnostic challenges posed by S. pyogenes primary peritonitis, particularly due to its rarity and clinical resemblance to appendicitis or pelvic inflammatory disease. Preoperative diagnosis is seldom made, with confirmation typically reliant on intraoperative findings and cultures. Literature review revealed only 46 reported English language cases of Group-A Streptococcus primary peritonitis since 1980, predominantly in female paediatric patients. Delay in diagnosis and treatment results in severe complications such as Streptococcal Toxic Shock Syndrome.

Conclusion: This case highlights the importance of early empirical broad-spectrum antibiotic therapy in suspected primary peritonitis cases. This ensures prompt treatment while awaiting definitive culture results, improving patient outcomes.