BACKGROUND:

Primary peritonitis is a rare entity observed in patients with chronic pathology. However, when it is caused by Streptococcus pyogenes the most affected population are young women with no medical history, and can lead to a more serious condition, such as sepsis.

CLINICAL CASE:

A 30-year-old woman, who consults for severe abdominal pain accompanied by fever, showed signs of peritoneal irritation and pain on cervical mobilization. Imaging tests showed nonspecific signs, without signs that suggested perforation. An exploratory laparoscopy was performed because of the signs of acute abdomen. The only finding during the surgery was a large amount of purulent fluid, which was referred for microbiological study. Hours later, the patient had progressive deterioration, with hypotension, tachycardia, tachypnea and oliguria. The laboratory tests showed alteration of coagulation and increase of infectious parameters. Due to clinical and analytical deterioration, we decided to admit the patient on the intensive care unit, with the diagnosis of secondary sepsis. In culture of cervix, urine, peritoneal fluid and in blood cultures S. pyogenes was isolated. Finally, primary peritonitis due to S. pyogenes with secondary sepsis was diagnosed and treated with broad spectrum antibiotics.

CONCLUSION:

In a case of peritonitis in young woman without comorbidity and with imaging tests without findings, we should suspect in a primary peritonitis caused by S. pyogenes. The diagnosis is very difficult and usually several imaging tests and even surgical interventions are performed to try to reach a correct diagnosis.