Toxic shock syndrome (TSS) may occur in a patient with peritonitis if the causative organism is toxigenic. The diagnosis can be difficult if the possibility of TSS is not considered.
Organisms associated with TSS:
(1) Staphylococcus aureus
(2) Streptococcal pyogenes (Group A)
(3) rarely other species of Streptococcus
Clinical features:
(1) primary peritonitis, peritonitis associated with acute salpingitis or surgical site infection
(2) presence of toxic shock syndrome with hypotension and multi-organ failure
(3) isolation of toxigenic strain of bacteria
(4) reversal of findings on aggressive antibiotic therapy and supportive care
The primary peritonitis may follow an upper respiratory tract infection or other extra-peritoneal site.
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