Group G Streptococcus - A Rare Cause of Peritonitis: A Case Report

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Purpose: A 54-year-old female on continuous ambulatory peritoneal dialysis for 19 years presented with generalized, dull abdominal discomfort associated with non-bilious vomiting for four days. She denied sick contacts and pets at home. Physical examination was remarkable for normal bowel sounds, soft, distended abdomen with generalized tenderness. There was no erythema or increased warmth around dialysis catheter site. Initial laboratory tests were unremarkable including white blood cell count. Cultures from the peritoneal fluid grew Streptococcus G. Patient was started on antibiotics with peritoneal dialysis. Repeat peritoneal fluid and blood cultures were negative. Computed tomography (CT) of the abdomen and pelvis revealed large abdominal and pelvic ascites with no abscess or fluid collection. Due to patient's persistent abdominal tenderness and distension, peritoneal catheters were removed and patient was started on hemodialysis. Discussion: Beta-hemolytic Streptococci group G comprises of 2 species: a small colony forming Streptococcus milleri group and a large colony Streptococcus canis group, the majority of S. canis are isolated from the skin, pharynx, vagina and gastrointestinal tract.(1,2) Pharyngitis, septic arthritis, endocarditis, cholangitis, cholecystitis, liver infections, pneumonia and skin and soft tissue infections are associated with large colony Streptococcus G.(3)Small colony Streptococcus G can cause peritonitis as a complication of hematogenous spread or through bowel perforation. (3) We believe that our patient had infection from the skin via peritoneal catheters. A pharyngeal swab was negative for Streptococcus G. Infection with Streptococcus G is associated with underlying malignancy and chronic debilitating illnesses such as chronic alcoholism and uncontrolled diabetes mellitus. (4) Patients without any history of malignancy respond better to antibiotics especially with skin and soft tissue infections (4) Although, group G Streptococci are sensitive to penicillins, aminoglycosides are added for synergy.(5)