# Group A Streptococcal Toxic Shock Syndrome With Portal Vein Thrombosis: A Rare Presentation in Newborns

## TL;DR

A newborn developed a rare and severe group A Streptococcus infection with liver vein clotting, requiring intensive care and special treatment.

## Contribution

Highlights a rare presentation of group A Streptococcal toxic shock syndrome in newborns involving portal vein thrombosis.

## Key findings

- A term newborn presented with severe group A Streptococcus infection and portal vein thrombosis.
- Treatment included IV antibiotics, immunoglobulin, and enoxaparin, leading to clinical improvement.
- The infection was confirmed by blood culture matching the mother's milk isolate.

## Abstract

Invasive disease due to group A Streptococcus infection results in a large spectrum of clinical manifestations. In the neonatal period, the occurrence is rare and potentially serious.

We present a case of a term male newborn on the 9th day of life who was admitted to the emergency room with moaning and poor feeding. The patient was hemodynamically unstable needing mechanical ventilation and inotropic support. Mother and father had clinical symptoms of pharyngitis. Blood samples revealed high serum C-reactive protein and procalcitonin, leucopenia, thrombocytopenia, hyponatremia, hepatic cytolysis, and cholestasis. He started on IV ampicillin, gentamicin, and cefotaxime. Due to an abdominal distension, an ultrasound was done showing a heterogenous hepatic lobe. A color Doppler scan completed the study revealing a left hepatic thrombosis. Enoxaparin was started. The newborn's blood culture and mother's milk were positive for the same strain of group A Streptococcus. Intravenous immunoglobulin and clindamycin were added to the treatment. On day 5 of treatment, inotropic support was ceased and extubation took place on day 6. Neonatologists should be aware of rare complications of group A Streptococcus infection such as thrombotic events.