# Old Bug, New Challenge: Invasive Group A Streptococcus and a Rare Pediatric Holospinal Epidural Abscess

## TL;DR

A rare case of spinal infection caused by group A Streptococcus in a child is reported, highlighting the importance of early diagnosis and treatment.

## Contribution

This case report highlights a rare pediatric spinal abscess caused by invasive group A Streptococcus, raising clinical awareness.

## Key findings

- A 18-month-old child with invasive group A Streptococcus developed a holospinal epidural abscess.
- Conservative treatment with drainage and antibiotics led to full recovery without neurological damage.

## Abstract

Invasive group A Streptococcus (iGAS) infections have risen in the post-COVID-19 era, with significant morbidity and mortality in children. Spinal epidural abscess (SEA) is a rare, life-threatening condition, and pediatric cases are scarcely reported. SEA caused by iGAS is even more unusual, with only sporadic case reports in the literature. Herein, a challenging case of pediatric SEA due to iGAS is described, raising awareness of this clinical entity.

An otherwise healthy 18-month-old girl presented with a three-day history of gait disturbance, high temperature, and seizures. Lumbar puncture revealed pus, and cultures grew group A Streptococcus. Magnetic resonance imaging demonstrated a holospinal epidural abscess. The patient was managed conservatively with serial epidural needle drainage and prolonged intravenous antibiotics. She achieved complete clinical and radiological recovery without neurological sequelae.

Pediatric SEA is rare, but early recognition and appropriate management are essential to prevent irreversible complications. Clinicians should remain vigilant for spinal complications of iGAS infections to optimize outcomes.