Streptococcus pneumoniae Peritonitis and Enterocolitis in a Previously Healthy Female

Streptococcus pneumoniae rarely causes peritonitis; however, it has been associated with peritonitis in 3 major populations: in those with immunocompromising conditions, in association with gastrointestinal disease or surgery, and in previously healthy adult women from a genitourinary source. We present a case of a previously healthy 40-year-old woman who presented with symptoms of gastroenteritis. Initial workup revealed multiple dilated, thick walled, and fluid-filled loops of small bowel and S. pneumoniae bacteremia. She rapidly developed multiloculated ascites, significant peritonitis, enterocolitis, and a pelvic abscess. Polymerase chain reaction of her pelvic abscess identified S. pneumoniae. The patient was treated with multiple paracenteses, abscess drain placement, and antibacterial therapy. This case is noteworthy given the rarity of S. pneumoniae peritonitis and the severity of the patient's presentation. It is important for clinicians to be aware of the virulence of S. pneumoniae and consider this disease in a previously healthy female patient with peritonitis.