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Streptococcal Pharyngitis: Delving Deeper than the Throat
Sadaf Sheikh1, Umair Javed2, Muhammad Akbar Baig2
1Department of Emergency Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Abstract:
Acute rhabdomyolysis and elevated transaminases during streptococcal pharyngitis are rare presentations. The proposed pathophysiological mechanisms include direct bacterial invasion and toxin generation. Physicians should be aware of the association between these infections and the above-mentioned complications to facilitate optimal treatment of these patients. We present the case of a 18-years-old gentleman with β-haemolytic streptococcal pharyngitis complicated by rhabdomyolysis and elevated liver function tests. Such high levels of creatine phosphokinase of 111856 IU/L and elevated liver function tests with aspartate aminotransferase (AST) of 1862 U/L and alanine aminotransferase (ALT) of 1003 U/L in streptococcal pharyngitis is rare to find in the literature. He was treated with aggressive intravenous hydration, antibiotics and hemodialysis. Key Words: Rhabdomyolysis, β-haemolytic Streptococci, Creatine phosphokinase, Liver function tests.
Insights
A rare case of severe rhabdomyolysis and elevated liver function tests occurred in an 18-year-old with streptococcal pharyngitis. Prompt treatment included hydration, antibiotics, and hemodialysis.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Toxicology
Background:
- Streptococcal pharyngitis is common, but severe complications like rhabdomyolysis and liver dysfunction are rare.
- Understanding the pathophysiology, including bacterial invasion and toxin effects, is crucial.
Observation:
- An 18-year-old male presented with β-hemolytic streptococcal pharyngitis.
- He developed acute rhabdomyolysis with extremely high creatine phosphokinase (111,856 IU/L).
- Significant elevation in liver function tests, including AST (1862 U/L) and ALT (1003 U/L), was noted.
Findings:
- This case highlights an exceptionally rare presentation of streptococcal pharyngitis.
- The patient experienced severe muscle breakdown and liver injury, indicated by markedly elevated enzyme levels.
- The combination of these severe complications in the context of streptococcal pharyngitis is infrequently reported.
Implications:
- Physicians must consider rhabdomyolysis and elevated transaminases as potential complications of streptococcal pharyngitis.
- Early recognition and appropriate management, including hydration, antibiotics, and supportive care like hemodialysis, are vital.
- This case underscores the importance of recognizing and managing rare but serious infectious disease complications.
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