Cortese Francesco, Fransvea Pietro, Saputelli Alessandra, Ballardini Milva, Baldini Daniela, Gioffre Aldo, Marcello Roberto, Sganga Gabriele
Emergency Surgery and Trauma Care Unit - St Filippo Neri Hospital, Rome, Italy.
Faculty of Medicine and Psychology, University of Rome "La Sapienza", St. Andrea's Hospital, Via Di Grottarossa, 1035-39, 00189, Rome, Italy.
J Med Case Rep. 2019 Apr 28;13(1):126. doi: 10.1186/s13256-019-2038-3.
Primary peritonitis without an identifiable intra-abdominal source is extremely rare in healthy individuals; it is commonly seen in cases of nephrotic syndrome, cirrhosis and end-stage liver disease, ascites, immunosuppression, and inflamed peritoneum due to pre-existing autoimmune and oncological conditions.
We present the case of a 68-year-old Caucasian woman operated on due to acute abdomen with a provisional diagnosis of acute appendicitis. During the operation a small amount of free intra-abdominal fluid was found. Her uterus, ovaries, and fallopian tubes were macroscopically normal. Therefore, with the suspicion of appendicitis, appendectomy was performed. Her blood cultures were negative while peritoneal fluid was positive for capsulated form of Streptococcus pneumoniae. A 30-day follow-up was performed and she was asymptomatic without any sign of infection.
Streptococcus pneumoniae commonly causes upper respiratory tract infection and cutaneous infections. It very rarely causes gastrointestinal infection and it is very rarely responsible for primary peritonitis and septic shock syndrome.
Pneumococcal peritonitis has a rare occurrence and represents a clinical challenge because of its subtle and non-specific clinical findings. The interest in our case lays in the relatively rare diagnosis of primary peritonitis mimicking acute appendicitis.
原发性腹膜炎在无明显腹腔内感染源的健康个体中极为罕见；常见于肾病综合征、肝硬化和终末期肝病、腹水、免疫抑制以及既往存在自身免疫性和肿瘤性疾病导致的腹膜炎症患者。
我们报告一例68岁白种女性患者，因急性腹痛接受手术，初步诊断为急性阑尾炎。手术中发现少量腹腔内游离液体。其子宫、卵巢和输卵管肉眼检查正常。因此，怀疑为阑尾炎，遂行阑尾切除术。她的血培养结果为阴性，而腹腔积液培养出肺炎链球菌荚膜型阳性。进行了30天的随访，她无症状，无任何感染迹象。
肺炎链球菌通常引起上呼吸道感染和皮肤感染。它极少引起胃肠道感染，也极少导致原发性腹膜炎和感染性休克综合征。
肺炎球菌性腹膜炎发生率罕见，因其临床表现隐匿且不具特异性，构成临床挑战。我们病例的意义在于原发性腹膜炎误诊为急性阑尾炎的情况相对少见。
