[Atypical spontaneous bacterial peritonitis linked to streptococcal toxic shock syndrome].

Anamnesis and clinical examination: A 59-year-old female patient with an unremarkable medical history presented with watery diarrhea, severe lower abdominal pain, and fever for approximately 7 days. Physical examination revealed a distended abdomen, bowel sounds were absent, and there was an acute abdomen with generalized guarding and significantly elevated inflammatory markers.

Diagnosis: Abdominal computed tomography showed significant ascites and signs of peritonitis. Exploratory diagnostics were indicated. A laparoscopy was performed, which revealed diffuse purulent peritonitis. Organ perforation or other reasons for a peritonitis were excluded.

Therapy and clinical course: Bacteriological examination and blood cultures showed β-hemolytic group A streptococci, leading to the diagnosis of spontaneous bacterial peritonitis caused by streptococci. The patient was treated with antibiotics, progressively recovered, and was discharged symptom-free and without sequelae.

Conclusion: Primary spontaneous bacterial peritonitis caused by Streptococcus pyogenes is a rare cause of acute abdomen. An early diagnosis and immediate antibiotic therapy are crucial for prognosis.