Acute segmentary ulcerative duodenitis induced by Streptococcus pyogenes mimicking Inflammatory Bowel Disease

Dear Sir, Infection with Streptococcus pyogenes is common and worldwide in distribution. This pathogen is responsible for a variety of severe diseases (i.e., invasive infections and nonpurulent sequelae) which originate approximately 500,000 deaths each year as a whole.1 We report, to our knowledge, the first case of acute ulcerative duodenitis as a nonsuppurative complication of S. pyogenes infection. A 65-year-old woman was seen in the emergency department for severe abdominal pain, vomiting, and fever over the last 24 h. Ten hours before appearing with these complaints she had noticed malaise and sore throat. On admission, her temperature was 38.7 °C, her blood pressure was 112/75 mm Hg, and her heart rate was 88 beats/min. Physical examination was remarkable for pharyngeal redness, enlarged hyperemic tonsils, and increased epigastric pain upon palpation, although there was neither parietal muscular spasm nor rebound tenderness. Laboratory results were relevant for white blood cell count …