Allain-Jeannic Gwenola, Traversier Nicolas, Belmonte Olivier, Valance Dorothée, Bekkar Sarah, Allou Nicolas, Allyn Jerome
Service d'accueil des urgences Service de réanimation polyvalente Laboratoire de Bactériologie, Virologie, Parasitologie Service de chirurgie digestive, Centre hospitalier universitaire Félix-Guyon, Allée des Topazes, Saint Denis, France.
Medicine (Baltimore). 2018 Jul;97(28):e11323. doi: 10.1097/MD.0000000000011323.
Very few cases of secondary peritonitis caused by Streptococcus pneumoniae have been described in the literature, and they have been found to occur mostly in patients with predisposing factors. Here, we report the case of an elderly patient who developed pneumococcal peritonitis secondary to perforation of gastroduodenal ulcer.
An 82-year-old man was admitted to intensive care unit (ICU) for septic shock with cardiac impairment 1 day after arriving in the Emergency Department.
The patient presented with pneumococcal bacteremia and pneumococcal antigenuria. No abdominal defense was found on examination. A computed tomography scan revealed pneumoperitoneum and peritoneal effusions.
The patient was treated with effective empiric antibiotic therapy, and delayed surgery.
The patient gradually improved and was discharged from ICU on day 14. The ultimate outcome was unfavorable, with death occurring on day 28.
This rare infection can occur in elderly patients even in the absence of other predisposing factors. Secondary peritonitis may be suspected in patients with positive pneumococcal antigenuria or unexplained pneumococcal bacteremia, especially if an asthenic form is possible.
文献中描述的由肺炎链球菌引起的继发性腹膜炎病例极少，且大多发生在有易感因素的患者中。在此，我们报告一例老年患者，其因胃十二指肠溃疡穿孔继发肺炎球菌性腹膜炎。
一名82岁男性在抵达急诊科1天后因感染性休克伴心脏损害入住重症监护病房（ICU）。
患者出现肺炎球菌血症和肺炎球菌抗原尿。检查未发现腹部防御反应。计算机断层扫描显示气腹和腹腔积液。
患者接受了有效的经验性抗生素治疗，并延迟手术。
患者逐渐好转，于第14天从ICU出院。最终结局不佳，于第28天死亡。
这种罕见感染即使在没有其他易感因素的老年患者中也可能发生。肺炎球菌抗原尿阳性或不明原因肺炎球菌血症的患者，尤其是可能出现无力型的患者，可能怀疑有继发性腹膜炎。
