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Abstract：
Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as Streptococcus pyogenes) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis. A diagnostic laparoscopy confirmed primary peritonitis with an unknown infection source and causative pathology, as the appendix, ovaries and bowels were healthy-looking. Fluid cultures returned positive for GAS Pyogenes, while blood and urine cultures were negative. The discussion reviews the challenges in diagnosis and treatment of GAS primary peritonitis, highlighting the need for clinical suspicion, early diagnosis via laparoscopy or laparotomy and prompt antibiotic therapy as the current standard for treatment.
摘要：
原发性自发性细菌性腹膜炎（SBP）是先前健康患者中罕见的急腹症原因，更不寻常的是由A组链球菌（GAS）（也称为化脓性链球菌）感染引起的。我们报道了一个年轻人，其他健康的女性，表现为广泛性腹痛，最初保守治疗为胃肠炎，计算机断层扫描（CT）扫描显示黄体囊肿破裂。在随后疼痛和症状加重的再次入院时，重复CT扫描显示游离液体恶化，有腹膜炎的迹象。诊断性腹腔镜检查证实原发性腹膜炎，感染源和致病病理未知，作为附录，卵巢和肠道看起来很健康。流体培养物返回GASPyogenes阳性，而血液和尿液培养均为阴性。讨论回顾了GAS原发性腹膜炎诊断和治疗的挑战，强调临床怀疑的必要性，通过腹腔镜或剖腹手术进行早期诊断，并及时将抗生素治疗作为当前的治疗标准。
