A previously healthy 7-month-old boy was referred for fever and abdominal distension which had started 3 days previously. At admission, the patient had a compromised clinical condition and signs of severe sepsis. His abdomen was distended, presenting marked hepatosplenomegaly. The laboratory investigation revealed anemia (Hb 7.6g/dL), a leukocyte count of 3.86×109/L (77% neutrophils, 15% lymphocytes), severe thrombocytopenia (29×109/L), and an elevated C-reactive protein (390mg/L). Community pneumonia was confirmed after a chest X-ray analysis.
Due to hepatosplenomegaly and cytopenias, a bone marrow sample was analyzed and the results revealed intense infiltration by gram-positive bacteria arranged in chains, free in the smear and in the cytoplasm of neutrophils and macrophages (Figure 1).1,2 Blood and pleural effusion cultures revealed the rapid growth of Streptococcus pyogenes colonies.
The authors declare no conflicts of interest.
