A Case of Streptococcal Toxic Shock Syndrome Presented with Peritonitis following Influenza Infection

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  • URA Katsuro
    Junior resident, Nippon Telegraph and Telephone East Corporation Sapporo Hospital
  • MIURA Takumi
    Department of Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital
  • KONISHI Kazuya
    Department of Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital
  • TAKEMOTO Norihiro
    Department of Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital
  • MIYASAKA Yuji
    Department of Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital

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Other Title
  • インフルエンザ感染後に腹膜炎で発症した劇症型A群溶連菌感染症の1例
  • 症例 インフルエンザ感染後に腹膜炎で発症した劇症型A群溶連菌感染症の1例
  • ショウレイ インフルエンザ カンセン ゴ ニ フクマクエン デ ハッショウ シタ ゲキショウガタ Aグン ヨウレンキン カンセンショウ ノ 1レイ

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A 39-year-old woman was referred to our hospital from a neighboring hospital because of abdominal pain, diarrhea, and an abnormally high level of CRP after treatment for influenza A infection. There were abdominal distention and peritoneal sign. Abdominal CT scan showed massive ascites and a swollen left ovary. Exploratory laparotomy was performed with a diagnosis of general peritonitis. Large volumes of purulent ascites and a chocolate cyst of the left ovary were identified, and left adnexectomy and intraabdominal lavage and drainage were performed. After the operation, she developed systemic inflammatory response syndrome (SIRS), disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and acute renal failure, so that continuous hemodiafiltration (CHDF) and polymyxin-B direct hemoperfusion (PMX-DHP) were started that achieved stable circulatory kinetics. Group A Streptococcus was isolated from a culture of the blood and ascites. Streptococcal toxic shock syndrome (STSS) was thus diagnosed. Antibiotic therapy mainly with penicillin was successful.<BR>Causative factors resulting in general peritonitis in this patient are undetermined, but a possibility that the preceding infection with influenza virus might induce STSS could not be ruled out. Although STSS associated with peritonitis is rare, early surgical drainage and multimodal treatment are essential.

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