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

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Abstract

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.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

FLF:

Fulminant liver failure

GAS:

Group A streptococcal

SPE:

Streptococcal pyrogenic exotoxins

STSS:

Streptococcal toxic shock syndrome

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Acknowledgements

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.

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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). https://doi.org/10.1007/s00431-002-1137-z

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Keywords

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