Abstract
Mentors: Andrea Green Hines, Arthur Chang Program: Pediatrics Type: Case Report Background: Group A Strep (e.g., Streptococcus pyogenes) is an aerobic gram-positive coccus that commonly causes bacterial pharyngitis and less commonly causes invasive infection of sterile sites in the body such as bacteremia, pneumonia, septic arthritis, as well as many others. Most invasive diseases are preceded by a viral infection. Case: This case involves a 16 year old previously healthy male who was transferred from an outside hospital due to altered mental status with a reported 8 day history of vomiting and several days of sore throat. He was found to have COVID-19 and Epstein-Barr virus infections. In our ED he was noted to be febrile and disoriented with a GCS of 11; an LP was attempted but was unsuccessful. On admission to the PICU, ceftriaxone was initiated, and vancomycin was added on the following day. A sedated LP with IR and MRI were performed on hospital day #2; CSF studies were remarkable for pleocytosis of 8,000 WBCs, negative Meningitis/Encephalitis panel with a positive culture that grew gram-positive cocci resembling Strep species. A broad range bacterial polymerase chain reaction (PCR) test of CSF sent out identified group A Strep. The patient was transitioned to penicillin. Due to complications of right lenticular striate branch middle cerebral artery infarct, the patient had a prolonged hospital stay with plans in place for inpatient rehabilitation. Conclusion: Although majority of the time group A Strep causes minor infections, it can cause invasive disease in children with a high mortality rate and should be considered with serious infections.