A 9-year-old boy with pharyngitis for 7 days and high fever and arthralgia in the 48 hours prior to admission.
After staying in the hospital for 12 hours, the patient was admitted to the intensive care unit (ICU) with a punctiform petechial rash predominantly in the root of limbs, poor peripheral perfusion, hypotension, tachycardia, increased urine output.
In the complementary examinations stands out leukopenia (3.600/mm3), platelet count decreased to 20% (liver rate: 2000/mm3), C-reactive protein (11.96 mg/dl), bilirubin increased to 30% mEq/l
Expansion, administration of sodium bicarbonate, antibiotics (cefotaxime and teicoplanin) and infusion of catechols (dopamine 5 μg/kg/min and noradrenaline up to 8 μg/kg/min) were initiated.
It requires intubation and connection to mechanical ventilation due to worsening of gas exchange with high respiratory assistance.
He was admitted with continuous venous catheter due to renal failure and volume overload.
The evolution is unfavorable to refractory multiorgan failure (MOF), resulting in asystole and cardiorespiratory arrest, with death 12 hours after admission.
S. pyogenes serotype M1T1 was isolated in blood culture and bronchial aspirate.
