title: Fulminant liver failure in a child with invasive group A streptococcal infection.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics and Pediatric Surgery, University Hospital of Geneva, 1211 Geneva 14, Switzerland.
authors.forename: M-N
authors.initials: MN
authors.lastname: Biesel-Desthieux
authors.forename: P
authors.initials: P
authors.lastname: Tissières
authors.forename: D C
authors.initials: DC
authors.lastname: Belli
authors.forename: C
authors.initials: C
authors.lastname: Le Coultre
authors.forename: A
authors.initials: A
authors.lastname: Gervaix
authors.forename: V
authors.initials: V
authors.lastname: Masserey Spicher
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000096:biosynthesis / Q000235:genetics; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D005098:Exotoxins / Q000096:biosynthesis / Q000235:genetics; D006801:Humans; D017093:Liver Failure / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D013297:Streptococcus pyogenes / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D010406:Penicillins; D002981:Clindamycin; D010400:Penicillin G