Pneumococcal Peritonitis in Patients with Postnecrotic Cirrhosis

Abstract

Six episodes of pneumococcal peritonitis in five patients with postnecrotic cirrhosis, portal hypertension and ascites are reported. This diagnosis must be considered when fever or abdominal complaints, especially with leukocytosis, occur in patients with postnecrotic cirrhosis with ascites. Onset may be insidious. Physical examination and gross characterization of ascitic fluid were not diagnostic. Cell counts and Gram-stained smears of ascitic fluid provided first evidence of bacterial peritonitis. Adequate bacteriologic studies of blood and ascitic fluid established definitive diagnosis. Bactericidal levels of penicillin were demonstrated in ascitic fluid after a relatively small intravenous dose. Therapeutic responses to parenteral penicillin were prompt and successful with respect to the pneumococcal peritonitis. However, in four patients the peritonitis occurred as a preterminal event or was followed by other complications that caused death.