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.
CRP: C-reactive protein; CT: Computed tomography; EUCAST: European Committee on Antimicrobial Susceptibility Testing; HCV: Hepatitis C virus; IUD: Intrauterine device; MALDI-TOF: Matrix-assisted laser desorption/ionization time-of-flight; MICs: Minimum inhibitory concentrations; PID: Pelvic inflammatory disease; PP: Primary peritonitis; WBC: White blood cells
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J Med Case Reports. 2019;13(126) © 2019 BioMed Central, Ltd.