An 18-month-old boy presented to the emergency department with a 72-hour fever, refusal to eat, and vomiting.
Clinical examination revealed malaise, disconnection of the environment, hyporeactivity, tachycardia, hypotension, cystis and generalized petechial petechial rash.
Additional tests include leukopenia (3,700/mm3), hyponatremia (123 mEq/l), renal function at the upper limit of normal for his age (active fibrinolytic acidosis mEq/dl; active thromboplastin time: 37 mEq/dl).
After expansion and administration of sodium bicarbonate, dopamine 10 μg/kg/min, norepinephrine 0.2 μg/kg/min, and empirical antibiotic therapy with cefoxime are initiated.
Nasotracheal intubation and connection to mechanical ventilation were performed.
After the first hour of admission, the patient presented massive hemoptysis, with anemia, hemodynamic and respiratory deterioration, extreme bradycardia and asystole unresponsive to resuscitation measures, and died 2 hours after admission.
The autopsy study reports the existence of a bilateral diffuse bronchopneumonia with foci of culture in abscess secretion, generalized pulmonary edema, cerebral edema and cerebral enclaving, in which S. pyogenes was isolated
