Clinical Infection in Practice · Published 2026-07-10 · DOI 10.1016/j.clinpr.2026.100711
Oussama Grari, Abderrazak Saddari, Mohammed Lahmer, Mohammed Khalil Bourchid, Mohammed Meziane, Imane El Yandouzi, Ahmed Khalaf, Said Ezrari, Mostafa Elouennass, Adil Maleb
Background: Acute appendicitis is a common surgical emergency that may progress to severe complications such as perforation, generalized peritonitis, and intra-abdominal abscesses. Intra-abdominal infections are typically polymicrobial and rarely involve uncommon pathogens such as Enterococcus avium.Case report: We report a rare case of perforated appendicitis with generalized peritonitis caused by E.avium in a 45-year-old woman with schizophrenia treated with chlorpromazine, who presented with isolated diffuse abdominal pain without associated symptoms. Laboratory investigations revealed a marked inflammatory response, and abdominal computed tomography confirmed generalized appendicular peritonitis with multiple intra-abdominal abscesses. Emergency laparotomy revealed a perforated latero-cecal appendix with extensive purulent collections, and appendectomy with peritoneal lavage and drainage was performed. Microbiological analysis of peritoneal fluid identified E. avium using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The isolate demonstrated broad susceptibility to multiple antimicrobial classes. The patient received empirical intravenous ceftriaxone plus metronidazole, followed by oral ciprofloxacin and metronidazole after microbiological identification and antimicrobial susceptibility testing. She recovered without postoperative complications and remained asymptomatic at the 1-month follow-up.Conclusion: This case highlights the potential of E. avium to cause severe intra-abdominal infections, the importance of considering atypical presentations that may delay diagnosis, and the critical role of advanced microbiological techniques in guiding appropriate therapy.
Abstract from DOAJ. Public domain (CC0 1.0).
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Grari, O., Saddari, A., Lahmer, M., et al. (2026). Perforated appendicitis with generalized peritonitis caused by Enterococcus avium: a case report and literature review. Clinical Infection in Practice. https://doi.org/10.1016/j.clinpr.2026.100711