An unusual cause of a spontaneous bacterial peritonitis in a young healthy woman

The mortality rate of invasive GAS infections ranges from 25 to 48%, but the mortality of patients who develop shock is higher (30 to 70%).1,2 Primary GAS peritonitis is a rare condition occurring in patients without underlying causes such as a perforated viscus or pre-existing ascites.3 We report a case of young woman with a primary peritonitis and toxic shock syndrome (TSS) caused by GAS. Most patients with primary peritonitis are women, suggesting an ascending genital route.11 Factors such as intrauterine contraceptive devices (IUD) or recent vaginal delivery or caesarean section seem to play a predisposing role. [...]GAS does not commonly belong to the normal female vaginal flora (colonisation is less than 1%).12 Carriers usually are asymptomatic.13 Cases have been reported with infections related with the use of IUD, but also cases of GAS peritonitis and salpingitis with no history of IUD use are known.14-16 Puerperal sepsis due to GAS has been reported.17 Other Gram-positive isolated related to primary peritonitis are pneumococci, beta-haemolytic streptococci, and staphylococci.18 Combined treatment with penicillin G and clindamycin is recommended, because GAS isolates with clindamycin resistance have been reported in Europe.19 The length of therapy depends on the clinical response, but therapy is usually continued for a minimum of 2 weeks.