During the second operation massive
purulent ascites was found. However, neither hollow visceral
organ perforation nor any other focus could be detected. Despite
all efforts, the patient remained in septic shock and died within
24 h after admission from multiorgan failure. Blood cultures of the
peritoneal fluid were positive for GAS. Furthermore, histological
examination of the appendix confirmed infection with -hemolytic
group A Streptococci.