Affiliations: Department of Pediatrics, Gold Coast Hospital,
Southport, Queensland, Australia
Note: [] Correspondence: Benjamin Kenny, MD, Department of Pediatrics,
Gold Coast Hospital, Southport, Queensland, Australia. Tel.: +61 7 5519 8211;
E-mail: kennybenjamin@hotmail.com
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.
