RT Journal Article
SR Electronic
T1 Recurrent invasive group A streptococcal infection with four-limb amputation in an immunocompetent child
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2018-225292
DO 10.1136/bcr-2018-225292
VO 2018
A1 Nour Gazzaz
A1 Timothy Mailman
A1 Jennifer Ruth Foster
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2018-225292.abstract
AB We report a previously well paediatric patient with two distinct presentations of invasive group A streptococcus (GAS) infection resulting in significant morbidity. The first episode, following GAS pharyngitis, involved multiorgan dysfunction syndrome. This included cardiorespiratory and acute hepatorenal failure and purpura fulminans that eventually necessitated four-limb amputation. The second episode occurred 12 months later, from undetermined aetiology, and resulted in septic shock. Molecular analysis of the emm gene and PCR for Serum Opacity Factor revealed that the initial isolate was M Type 4 and sof gene positive while the second isolate was M Type 1 and sof gene negative. Immunological investigations, including CH50, quantitative IgA, IgM and IgG, and flow cytometry measuring lymphocyte subsets, and vaccine response to measles, mumps, rubella and pneumococcus were normal. This is the first report of recurrent bacteraemia from different strains of Streptococcus pyogenes infection in an apparently immunocompetent child.