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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Fulminant liver failure
Group A streptococcal
Streptococcal pyrogenic exotoxins
Streptococcal toxic shock syndrome
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
American Academy of Pediatrics: Committee on Infectious Diseases (1998) Severe invasive group A streptococcal infections: a subject review. Pediatrics 101: 136–140
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
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
Girisch M, Heininger U (2000) Scarlet fever associated with hepatitis A report of two cases. Infection 28: 251–253
Kocak N, Ozsoylu S, Ertugrul M, Ozdol G (1976) Liver damage in scarlet fever. Clin Pediatr 15: 462–464
MacMahon HE, Mallory FB (1931) Streptococcus hepatitis. Am J Pathol 7: 299–325
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
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
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
Price VF, Miller MG, Jollow DJ (1987) Mechanisms of fasting-induced potentialisation of acetaminophen hepatotoxicity in the rat. Biochem Pharmacol 36: 427–433
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
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
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
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
Stevens DL (2001) Invasive streptococcal infections. J Infect Chemother 7: 69–80
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.
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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
- Group A streptococcus
- Invasive infection
- Fulminant liver failure
- Streptococcal pyrogenic exotoxin