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Case report
Streptococcus pyogenes peritonitis: a rare, lethal imitator of appendicitis
  1. Matthew Johnson1,
  2. Ashley Bartscherer1,
  3. Ellis Tobin2 and
  4. Marcel Tafen1
  1. 1 Department of Surgery, Albany Medical College, Albany, New York, USA
  2. 2 Upstate Infectious Disease, Albany, New York, USA
  1. Correspondence to Matthew Johnson, mjohn7wy{at}


Streptococcus pyogenes is a common cause of infection. Since 2010, the Centers for Disease Control has noted a 24% rise in invasive S. pyogenes infections with a mortality rate of 10%. We present a case series and review of the English literature. Two patients presented with findings concerning for appendicitis, each underwent laparoscopic appendectomies. Both had diffuse peritoneal inflammation without appendicitis, cultures grew S. pyogenes and both recovered with appropriate antibiotics. Thirty cases were identified in a review of the English literature. The average age was 27 years, 75% were in women, 9% were immunocompromised, 15% had rashes and 88% underwent surgical intervention. Previous work identified female gender, immunosuppression and preceding varicella infection as risk factors for invasive S. pyogenes. Given the similarities to appendicitis, early suspicion can influence antibiotic therapy and possibly improve outcomes.

  • general surgery
  • infectious diseases

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  • Contributors MT, AB and MJ: the conception and design of the study, or acquisition of data, or analysis and interpretation of data. MT, AB, MJ and ET: drafting the article or revising it critically for important intellectual content and final approval of the version to be submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.