Group A Streptococcus and hepatitis – streptococcal toxic shock syndrome

Abstract

Group A streptococcal infection is common and has varied presentations. Group A streptococcus (GAS) is known to cause throat infections, erysipelas, scarlet fever and impetigo. Other more serious diseases caused by GAS are rheumatic fever and post streptococcal glomerulonephritis. There have been case reports showing an association with scarlet fever and jaundice postulating a direct effect of the erythrogenic toxin on the liver. We describe two cases; the first was a 13-year-old male who presented an atypical presentation of streptococcal infection with an acute hepatic picture who later developed septic arthritis, the second was a 7-year-old male who presented with disseminated intravascular coagulopathy, sepsis, jaundice and hepatic encephalopathy. In neither of the two cases did the children develop rashes of scarlet fever, desquamation or pharyngeal erythema. These were unique presentations highlighting the wide spectrum of GAS disease.