Streptococcus Pneumoniae Primary Peritonitis Mimicking Acute Appendicitis in an Immunocompetent Patient

A Case Report and Review of the Literature

Francesco Cortese; Pietro Fransvea; Alessandra Saputelli; Milva Ballardini; Daniela Baldini; Aldo Gioffre; Roberto Marcello; Gabriele Sganga


J Med Case Reports. 2019;13(126) 

In This Article


Primary pneumococcal peritonitis without pre-existing peritoneal disease is rare and represents a cultural and clinical challenge, especially for surgeons, because of its subtle and non-specific clinical findings. The interest in our case lays in the rare diagnosis of PP mimicking acute appendicitis in a healthy woman, without history of recent acute pneumonia or pelvic inflammatory disease (PID) and the isolation of pneumococcus in its capsulated form. This case report reinforces the need for an appropriate clinical algorithm in those patients without medical history and active comorbidities when the diagnosis of acute appendicitis is not clear at the time of operation, especially for female patients. No direct diagnosis is possible. The treatment of choice is the fast initiation of antibiotic therapy. Although surgical therapy is generally not required for the treatment of primary pneumococcal peritonitis, it may be necessary to exclude secondary peritonitis or in non-responders.