[Multifocal inflammatory syndrome after invasive infection due to an M1 strain of Streptococcus pyogenes]. / Manifestations inflammatoires réactionnelles multifocales après infection invasive à Streptococcus pyogenes de type M1.

We report on a case of Streptococcus pyogenes invasive disease with toxic shock syndrome due to an M1 strain producing SpeA and SmeZ superantigenic toxins. Post-streptococcal sequelae included several episodes of reactive arthritis and orchitis whose outcome was favorable with corticosteroid therapy. Invasive streptococcal infections are increasingly reported and may associate septic, toxinic, and immunological diseases. High-grade systemic inflammation may induce nonsuppurative complications and autoimmune diseases by molecular mimicry. Among them, reactive arthritis has been recognized as a separate entity from acute rheumatic fever and post-streptococcal orchitis has not been described before. Treatment should be quickly started and should be effective on the etiologic agent but also on its toxins due to the severity of the invasive infections associated with the spread of highly virulent bacterial clones and the potential development of multifocal nonsuppurative sequelae.

[Consequences of exclusive breast-feeding in vegan mother newborn--case report]. / Conséquences de l'allaitement maternel exclusif chez le nouveau-né de mère végétalienne--A propos d'un cas.

We report on the case of an infant who was hospitalized because of failure to thrive, megaloblastic anemia, and delayed psychomotor development. He was 10 months old and had been exclusively breast-fed by his vegan mother. Investigations showed vitamin B(12) deficiency with hematocytopenia and pervasive developmental disorders as well as vitamin K and vitamin D deficiencies. The infant's mother presented the same deficiencies. Introduction of vitamin supplementation normalized the biological disorders, and the infant showed weight gain and neurological improvement. This case highlights that a vegan diet during pregnancy followed by exclusive breast-feeding can induce nutritional deficiencies in the newborn, with clinical consequences. Detecting mother and child vitamin deficiencies and preventing them is essential.

[Splenic abscess caused by Ristella fragilis : a case report of a 2 years-old boy (author's transl)]. / Abcès pseudo-tumoral de la rate à "Ristella fragilis". A propos d'un cas chez un garçon de 2 ans.

This is a case report concerning a 2 years-old white boy who suffered sepsis fever with isolation in blood culture of an anaerobic bacteria (Ristella or Bacterioïdes fragilis). Despite continued specific therapy with clindamycine, a mass rapidly developed in the upper left portion of the abdomen which was investigated by plain film, barium enema, upper G.I. series and ultrasound study. The diagnosis of splenic abscess was only made at laparotomy. Splenectomy was a difficult procedure and needed an extension to the chest because of diaphragmatic adhesions. Culture of pus from the excised spleen grew bacteroides fragilis also, and metronidazole was added for therapy. Recover was uneventful with a 3 years follow-up. The authors emphasized the difficulty of clinical diagnosis of splenic abscess, the difficulty of bacteriological study of anaerobic bacteria and the scarceness of such cases, especially in pediatric literature. They ask the question about the legitimacy of splenectomy.