Spontaneous bacterial peritonitis presenting as a perforated viscus

Area of Science:

• Gastroenterology
• Nephrology
• Infectious Diseases

Background:

• Nephrotic syndrome is a kidney disorder characterized by heavy protein in the urine.
• Steroid therapy is a common treatment for nephrotic syndrome, but can lead to immunosuppression.
• Peptic ulcer disease symptoms can be exacerbated by steroid use.

Observation:

• A young male patient with severe nephrotic syndrome presented with symptoms mimicking peptic ulcer disease.
• The patient was undergoing treatment with corticosteroids.
• He subsequently developed peritonitis and pneumoperitoneum, indicating intra-abdominal complications.

Findings:

• Laparotomy revealed B. fragilis peritonitis.
• No evidence of gastrointestinal perforation was found.
• Ascites fluid culture confirmed Bacteroides fragilis as the causative agent.

Implications:

• This case suggests spontaneous primary peritonitis as a potential diagnosis in immunocompromised patients presenting with peritonitis.
• Bacteroides fragilis peritonitis can occur without perforation, particularly in patients on immunosuppressive therapy.
• Highlights the importance of considering non-surgical causes of peritonitis in patients with nephrotic syndrome and steroid treatment.