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[Secondary Streptococcus pyogenes peritonitis following necrotizing fasciitis]
S Gindre1, J Dellamonica, E Couadau
1Département d'anesthésie et réanimation Est, hôpital Saint-Roch, 5, rue Pierre-Devoluy, BP 1319, 06006 Nice cedex 1, France. stephanegindre@wanadoo.fr
Annales Francaises D'Anesthesie Et De Reanimation
|August 25, 2004
Summary
A 66-year-old woman with lupus and diabetes developed septic shock from Group A Streptococcus. Necrotizing fasciitis led to peritonitis and rapid death despite surgery.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Dermatology
Background:
- Disseminated lupus erythematosus and diabetes mellitus are significant comorbidities.
- Immunosuppressive therapy increases susceptibility to severe infections.
- Prompt recognition of invasive Group A Streptococcus is crucial.
Observation:
- A patient presented with inflammatory edema, abdominal pain, and vomiting, progressing to septic shock and multiple organ failure.
- Cutaneous lesions, including purpuric elements and hemorrhagic blisters, were noted but initially overlooked.
- Urgent laparotomy revealed peritonitis without evidence of gastrointestinal perforation.
Findings:
- Bacteriological samples confirmed Group A Streptococcus (Streptococcus pyogenes) in peritoneal fluid, blood, and skin lesions.
- The peritonitis was attributed to hematogenous spread from rapidly progressing necrotizing fasciitis.
- The patient succumbed to the overwhelming infection shortly after surgical intervention.
Implications:
- This case highlights the aggressive nature of invasive Group A Streptococcus infections, particularly in immunocompromised individuals.
- It underscores the importance of considering necrotizing fasciitis in patients with sepsis and unexplained skin lesions.
- Early diagnosis and aggressive management, including surgical debridement and targeted antibiotics, are critical for improving outcomes in such cases.