From Biopsy to Peritonitis: A Rare Case of Invasive Group a Streptococcus Pyogenes

Group A Streptococcus pyogenes (GAS) is a pathogenic bacteria capable of a wide spectrum of illness to include peritonitis: a rare but life-threatening condition. Initially diagnosed with a small bowel obstruction, this patient ultimately proved to have GAS peritonitis from a uterine biopsy - a complication not previously described. 1. Kanwal S, Vaitla P. Streptococcus Pyogenes. StatPearls Publishing; 2023. 2. Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control. Pathogens. Feb 22 2021;10(2)doi:10.3390/pathogens10020248 3. Massese M, La Sorda M, De Maio Ffdu, et al. Epidemiology of group A streptococcal infection: are we ready for a new scenario? The Lancet Microbe. 2024;5(7):620-621. doi:10.1016/S2666-5247(24)00071-5 4. Stevens D, Bryant A. Severe Group A Streptococcal Infections. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. University of Oklahoma Health Sciences Center; 2016. 5. Dunne EM, Hutton S, Peterson E, et al. Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008-2019. Emerg Infect Dis. Sep 2022;28(9):1785-1795. doi:10.3201/eid2809.212129 6. Tapiainen T, Launonen S, Renko M, et al. Invasive Group A Streptococcal Infections in Children: A Nationwide Survey in Finland. Pediatr Infect Dis J. Feb 2016;35(2):123-8. doi:10.1097/INF.0000000000000945 7. Sumiyama F, Sakaguchi T, Yamamichi K, Sekimoto M. Peritonitis caused by group A streptococcus: A case report and literature review. Int J Surg Case Rep. Mar 2022;92:106839. doi:10.1016/j. ijscr.2022.106839 8. Calatrava E. Other Streptococcus Species and Enterococcus. Encyclopedia of Infection and Immunity. 2022;1:529-541. doi:10.1016/B978-0-12-818731-9.00159-2 9. Barnett T, Indraratna A, Sanderson-Smith M. Secreted Virulence Factors of Streptococcus pyogenes. 2022 Jul 28 [Updated 2022 Nov 19]. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. 2nd edition. Oklahoma City (OK): University of Oklahoma Health Sciences Center; 2022 Oct 8. Chapter 13. https://www.ncbi.nlm.nih.gov/ books/NBK587095/ 10. Matsumoto Y, Shimizu A, Ogawa K, et al. Primary Peritonitis Due to Group A Streptococcus Successfully Treated with Intraperitoneal Drainage. Intern Med. May 01 2024;63(9):1229-1235. doi:10.2169/ internalmedicine.1933-23 11. Johnson M, Bartscherer A, Tobin E, Tafen M. Peritonitis: a rare, lethal imitator of appendicitis. BMJ Case Rep. Sep 30 2019;12(9) doi:10.1136/bcr-2019-230490 12. Senda A, Endo A, Fushimi K, Otomo Y. Effectiveness of intravenous immunoglobulin therapy for invasive group A Streptococcus infection: A Japanese nationwide observational study. Int J I