Bacterial peritonitis secondary to a perinephric abscess. Case report and differentiation from spontaneous bacterial...

A cirrhotic patient is described who presented with Escherichia coli septic arthritis as the first manifestation of a perinephric abscess. Results of baseline abdominal paracentesis were unremarkable. After 10 days of antibiotics, abdominal paracentesis was repeated because of recurrence of fever; E. coli peritonitis was confirmed. Subsequent autopsy revealed a perinephric abscess. Development of bacterial peritonitis during antibiotic treatment is distinctly unusual in the "spontaneous" form of peritonitis and should raise suspicion of secondary bacterial peritonitis.