Group A streptococcal primary peritonitis and toxic shock syndrome.

A 45-year-old healthy woman presented with peritonitis and septic shock, necessitating emergency surgery. Intraoperative findings did not definitively rule out secondary peritonitis, leading to a colon resection and ileostomy. However, the patient was later diagnosed with primary peritonitis caused by Group A streptococcus and complicated by streptococcal toxic shock syndrome (STSS). Given the poor prognosis and diagnostic challenges associated with STSS, surgeons should remain vigilant to the possibility of STSS in cases of peritonitis and ensure appropriate measures, including culture testing, are undertaken and provide aggressive systemic treatment alongside targeted therapy for the underlying condition.