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Fatal group A Streptococcus purpura fulminans in a child receiving TNF-α blocker

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Abstract

Inhibition of tumor necrosis factor alpha (TNF-α) is effective in the treatment of many pediatric autoimmune diseases and inflammatory conditions. Commonly available biologic agents blocking TNF-α are infliximab, etanercept, and adalimumab. These agents have changed the management of rheumatic diseases in the adult population and are being used more and more in pediatric patients as safety and efficacy have been demonstrated. Infections have been the most commonly reported adverse effects of TNF-α inhibition. Granulomatous infections such as tuberculosis are well-known complications, but serious bacterial infections are also reported. We describe a fatal case of purpura fulminans caused by group A Streptococcus in an 8-year-old child with systemic juvenile idiopathic arthritis treated with etanercept. This case highlights the clinical association of severe bacterial infection and TNF-α inhibition in children. Pediatricians should educate their patients who are treated with TNF-α blockers regarding early warning symptoms and should also have a lower threshold for initiating antibiotic therapy in case of fever.

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Acknowledgment

We thank Dr. Janet A. Englund for revising the manuscript and providing constructive comments.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, 3175 côte Sainte-Catherine (Québec), Montreal, Québec, Canada, H3T 1C5

    Christian Renaud, Philippe Ovetchkine & Bruce Tapiero

  2. Division of Plastic Surgery, Department of Surgery, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada

    Patricia Bortolozzi

  3. Division of Rheumatology, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, Québec, Canada

    Claire Saint-Cyr

  4. CHU Sainte-Justine, 3175 Chemin de la Côte Sainte-Catherine, Montréal, QC, Canada, H3T 1C5

    Bruce Tapiero

Authors
  1. Christian Renaud
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  2. Philippe Ovetchkine
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  3. Patricia Bortolozzi
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  4. Claire Saint-Cyr
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  5. Bruce Tapiero
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Corresponding author

Correspondence to Bruce Tapiero.

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Renaud, C., Ovetchkine, P., Bortolozzi, P. et al. Fatal group A Streptococcus purpura fulminans in a child receiving TNF-α blocker. Eur J Pediatr 170, 657–660 (2011). https://doi.org/10.1007/s00431-010-1341-1

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  • DOI: https://doi.org/10.1007/s00431-010-1341-1

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