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Scarlet fever associated with hepatitis--a report of two cases
1Pediatric Clinic, Friedrich-Alexander University of Erlangen-Nürnberg, Germany.
Insights
Group A beta-hemolytic streptococci (GABHS) infections can cause scarlet fever with hepatitis. Two boys recovered fully after antibiotic treatment for this rare GABHS complication.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hepatology
Background:
- Group A beta-hemolytic streptococci (GABHS) are a common cause of bacterial pharyngitis and tonsillitis in children.
- Scarlet fever, a GABHS infection, is characterized by a distinct rash.
- Hepatitis, or liver inflammation, can be a rare complication of various infections.
Observation:
- Two pediatric patients presented with symptoms of scarlet fever, including a scarlatiniform rash.
- Both patients exhibited signs of liver involvement, such as dark urine and light-colored stools.
- Initial laboratory tests ruled out common viral hepatitis (A, B, C), cytomegalovirus, and Epstein-Barr virus.
Findings:
- Elevated liver transaminases confirmed hepatic involvement in both scarlet fever patients.
- Patients received antibiotic treatment for the GABHS infection.
- Both children experienced complete recovery within days of treatment.
Implications:
- This case series highlights a potential, albeit uncommon, association between GABHS-induced scarlet fever and hepatitis.
- Physicians should consider hepatic involvement in children presenting with scarlet fever, especially when viral causes are excluded.
- Further research into the pathogenesis of scarlet fever-associated hepatitis is warranted to understand this clinical presentation better.
Abstract:
Infection with group A beta-hemolytic streptococci (GABHS) is the most common bacterial cause of acute pharyngitis and tonsillitis beyond infancy. We report on two patients with scarlet fever associated with hepatitis. The patients (boys aged 6 and 7 years) both presented with a scarlatiniform rash, dark urine and light-colored stools. Laboratory studies revealed elevated liver transaminases and negative antibody tests against hepatitis viruses A, B and C, cytomegalovirus and Epstein-Barr virus. Both patients were treated with antibiotics and recovered completely within a few days. Although the association between scarlet fever and hepatitis has been known for many decades, the pathogenesis is still unknown. Physicians treating patients with group A beta-hemolytic streptococcal infections should be aware of possible hepatic involvement.