Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Fulminant liver failure in a child with invasive group A streptococcal infection

  • 53 Accesses

  • 2 Citations


Liver involvement is mentioned in streptococcal toxic shock syndrome, but never as fulminant liver failure (FLF). We report the case of a 2-year-old child who developed isolated FLF secondary to invasive group A streptococcal infection without shock due to a M1T1-type strain expressing speA, speB and speC toxin genes. On antibiotics, he recovered rapidly without liver transplantation. Conclusion: A streptococcal pyrogenic exotoxin likely constituted the initial insult leading to FLF. This etiology can be included in the differential diagnosis of FLF and would support early introduction of antibiotics.

This is a preview of subscription content, log in to check access.



Alanine aminotransferase


Aspartate aminotransferase


Fulminant liver failure


Group A streptococcal


Streptococcal pyrogenic exotoxins


Streptococcal toxic shock syndrome


  1. 1.

    Alonso EM, Sokol RJ, Hart J, Tyson RW, Michael R, Narkewicz MR, Witington PF (1995) Fulminant hepatitis associated with centriIobular hepatic necrosis in young children. J Pediatr 127: 888–894

  2. 2.

    American Academy of Pediatrics: Committee on Infectious Diseases (1998) Severe invasive group A streptococcal infections: a subject review. Pediatrics 101: 136–140

  3. 3.

    Demers B, Simor AE, Vellend H, Schlievert PM, Byrne S, Jamieson F, Walmsley S, Low DE (1993) Severe invasive group A streptococcal infections in Ontario, Canada: 1987–1991. Clin Infect Dis 16: 792–800

  4. 4.

    Eriksson BK, Andersson J, Holm SE, Norgren M (1998) Epidemiology and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis 27: 1428–1436

  5. 5.

    Girisch M, Heininger U (2000) Scarlet fever associated with hepatitis A report of two cases. Infection 28: 251–253

  6. 6.

    Kocak N, Ozsoylu S, Ertugrul M, Ozdol G (1976) Liver damage in scarlet fever. Clin Pediatr 15: 462–464

  7. 7.

    MacMahon HE, Mallory FB (1931) Streptococcus hepatitis. Am J Pathol 7: 299–325

  8. 8.

    Mascini EM, Jansze M, Schellekens JFP, Musser JM, Faber JAJ, Verhoef-Verhage LAE, Schouls L, Van Leeuwen WJ, Verhoef J, Van Dijk H (2000) Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-toxin A antibodies. J Infect Dis 181: 631–638

  9. 9.

    Novak DA, Lauwers GY, Dolson DJ (2001) Bacterial, parasitic and fungal infections of the liver. In: Suchy FJ, Sokal RJ, Balistreri WF, eds. Liver disease in children. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, pp 845–867

  10. 10.

    Peltekian KM, Levy GA (1997) Role of cytokines and immune mechanisms in acute liver failure. In: Lee WM, Williams R, eds. Acute liver failure. Cambridge University Press, Cambridge, pp 67–78

  11. 11.

    Price VF, Miller MG, Jollow DJ (1987) Mechanisms of fasting-induced potentialisation of acetaminophen hepatotoxicity in the rat. Biochem Pharmacol 36: 427–433

  12. 12.

    Robbens E, De Man M, Schurgers M, Boelaert J, Lameire N (1986) Systemic complications of streptococcal scarlet fever: two case reports and a review of the literature. Acta Clin Belg 41: 311–318

  13. 13.

    Rolando N, Gimson A, Wade J, Philpott-Howard J, Casewell M, Williams R (1993) Prospective controlled trial of selective parenteral and enteral antimicrobial regimen in fulminant hepatic failure. Hepatology 17: 196–201

  14. 14.

    Rolando N, Wade J, Davalos M, Wendon J, Philipott-Howard J, Williams R (2000) The systemic inflammatory response syndrome in acute liver failure. Hepatology 32: 734–739

  15. 15.

    Sheron N, Keane H, Goka J, Alexander G, Williams R, Wendon J (2001) Circulating acute phase cytokines and cytokine inhibitors in fulminant hepatic failure: associations with mortality and haemodynamics. Clin Intensive Care 12: 127–134

  16. 16.

    Stevens DL (2001) Invasive streptococcal infections. J Infect Chemother 7: 69–80

Download references


We thank Dr. EM Mascini (Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, Utrecht University Hospital, the Netherlands) for the determination of serum antibodies to streptococcal pyrogenic exotoxins A and B.

Author information

Correspondence to A. Gervaix.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Biesel-Desthieux, M., Tissières, P., Belli, D.C. et al. Fulminant liver failure in a child with invasive group A streptococcal infection. Eur J Pediatr 162, 245–247 (2003).

Download citation


  • Group A streptococcus
  • Invasive infection
  • Fulminant liver failure
  • Child
  • Streptococcal pyrogenic exotoxin