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November 1, 1976

Clostridial Spontaneous Peritonitis

Author Affiliations

From the departments of medicine and pediatrics, Roger Williams General Hospital arid the Brown University Program in Medicine (Dr Peter) and the Department of Medicine, Rhode Island Hospital (Dr Brown), Providence.

JAMA. 1976;236(18):2095-2096. doi:10.1001/jama.1976.03270190051033

THE SYNDROME of spontaneous peritonitis and bacteremia is a welldocumented complication in cirrhotic patients with ascites.1Escherichia coli, other enteric Gram-negative rods, and Streptococcus pneumoniae account for most reported cases, while anaerobic bacteria are rare.1,2 Clostridia bacteremia has been noted in chronic alcoholics,3 but, to our knowledge, has not been previously associated with spontaneous peritonitis.

Report of a Case  A 54-year-old chronically alcoholic woman with biopsy-proved Laënnec cirrhosis, ascites, and esophageal varices demonstrated by prior esophagoscopy was admitted to the Rhode Island Hospital with hematemesis and melena of two days' duration. She did not have any other abdominal symptoms, fever, or chills. Significant past history included insulin-dependent diabetes mellitus. The patient was alert, in no acute distress, pale, and had a temperature of 38.8 C. The abdomen was distended with obvious ascites, but was nontender. Laboratory values included the following: hemoglobin, 6.7 gm/100 ml; leukocyte count, 13,400