Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report

Sam Hassan; Farsheed Zakir; Sameer Sajwani

doi:doi:10.11648/j.ajp.20180402.12

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Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report

Sam Hassan, Farsheed Zakir, Sameer Sajwani

Published in American Journal of Pediatrics (Volume 4, Issue 2)

Received: 23 April 2018 Accepted: 16 May 2018 Published: 12 June 2018

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Abstract

Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.

Published in	American Journal of Pediatrics (Volume 4, Issue 2)
DOI	10.11648/j.ajp.20180402.12
Page(s)	25-30
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Streptococcal Infection, Scarlet Fever, Vitamin D Deficiency, Vasculitis

References

[1]	Thompson K, Sterkel A K, McBride J A, and Corliss R F; The Shock of Strep: Rapid Deaths Due to Group A Streptococcus; 2018; Acad Forensic Pathol. 8(1): 136-149.
[2]	Martins AL, Figueiredo AE, Brito MJ (2015) Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome. Clin Res Infect Dis 2(1): 1011.
[3]	Brahmadathan NK (2017); Molecular biology of Group A Streptococcus and its complications in vaccine strategies; Indian J of Med Microbiol; 35: 176–183.
[4]	Rajgor AD, Hakim NA, Ali S and Darr Adnan, (2018); Paediatric Autoimmune Neuropsychatric Disorder Associated with Group A Beta-Haemolytic Streptococcal infection: An indication for tonsillectomy? A review of the literature; Internation J of Otolaryngology cited on: https://doi.org/10.1155/2018/2681304.
[5]	Martins AL, Figueiredo AE, Brito MJ (2015) Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome. Clin Res Infect Dis 2(1): 1011.
[6]	Zitelli, Basil; McIntire, Sara; Nowalk, Andrew (2018). Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. Elsevier, Inc.
[7]	You Y, Davies M R, Protani M, McIntyre L, Walker M J, and Zhang J; (2018); Scarlet Fever Epidemic in China Caused by Streptococcus pyogenes Serotype M12: Epidemiologic and Molecular Analysis; EBioMedicine 28: 128–135.
[8]	Wei L, Xianfen C, Linying G, Hongri L, Cunrong S, Xiaodai C, Qi Z, and Guowei S, (2018); Association between serum 25-hydroxyvitamin D concentration and pulmonary infections in children; Medicine; 97: 1: p e9060; doi: 10.1097/MD.0000000000009060.
[9]	Berry DJ, Hesketh K, Power C, Hypponen E. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr 2011; 106:1433–40.
[10]	Mulrennan S, Knulman M, Walsh J P, Hue J, Hunter M, Divitini M, Zhu K, Cooke B R, Musk A W, and James A; (2018); Vitamin D and respiratory health in the Busselton Healthy Ageing Study; Respirology (2018). Cited on DOI: 10.1111/resp.13239.
[11]	Dąbrowska-Leonik N, Bernatowska E, Pac M, Filipiuk W, Mulawka J, Pietrucha B, Heropolitańska-Pliszka E, Bernat-Sitarz K, Wolska-Kuśnierz B, and Mikołuć B. (2018); Vitamin D deficiency in children with recurrent respiratory infections, with or without immunoglobulin deficiency. Adv Med Sci. 63(1):173-178.
[12]	Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, et al. Toll-like receptor Triggering of a vitamin D-mediated human antimicrobial response. Science 2006; 311:1770–3.).
[13]	Holland M et al; Hypogalactosylation of serum IgG in patients with ANCA-associated systemic vasculitis; Clin Exp Immunol 2002; 129:183–190.
[14]	Nair R and Maseeh A; Vitamin D: The sunshine vitamin; 2012; J Pharmacol Pharmacother; 3 (2): 116 – 126.
[15]	Blyth CC, Robertson PW. Anti-streptococcal antibodies in the diagnosis of acute and post-streptococcal disease: streptokinase versus streptolysin O and deoxyribonuclease B. Pathology. 2006;38(2):152-6.
[16]	Johnson DR, Kurlan R, Leckman J, Kaplan EL. The Human Immune Response to Streptococcal Extracellular Antigens: Clinical, Diagnostic, and Potential Pathogenetic Implications. Clinical Infectious Diseases. 2010; 50(4):481-490.
[17]	Mahyar A, Ayazi P, Safari S, Dalirani R, Javadi A, and Esmaeily S. (2018); Association between vitamin D and urinary tract infection in children; Korean J Pediatr; 61(3): 90–94. doi: 10.3345/kjp.2018.61.3.90.
[18]	Bikle D. Nonclassic actions of vitamin D. J Clin Endocrinol Metab. 2009; 94(1):26–34. [PubMed: 18854395].
[19]	Ginde AA, Mansbach JM, Camargo CA Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009; 169(4):384–90. [PubMed: 19237723].
[20]	Laaksi I, et al. An association of serum vitamin D concentrations < 40 nmol/L with acute respiratory tract infection in young Finnish men. Am J Clin Nutr. 2007; 86(3):714–7. [PubMed: 17823437].
[21]	Cannell JJ, et al. Epidemic influenza and vitamin D. Epidemiol Infect. 2006; 134(6):1129–40. [PubMed: 16959053].
[22]	Bodnar LM, Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. J Nutr. 2009; 139(6):1157–61. [PubMed: 19357214].
[23]	Amado CA, and Perez MR; (2018); Vitamin D nutritional status and infectious diseases; J Infect Dis Ther 2018, 6:1; 349; DOI: 10.4172/2332-0877.1000349.
[24]	Rodriguez M, et al. High frequency of vitamin D deficiency in ambulatory HIV-Positive patients. AIDS Res Hum Retroviruses. 2009; 25(1):9–14. [PubMed: 19108690]).
[25]	Lemire JM, et al. 1 alpha, 25-dihydroxyvitamin D3 suppresses proliferation and immunoglobulin production by normal human peripheral blood mononuclear cells. J Clin Invest. 1984; 74(2):657– 61. [PubMed: 6611355].
[26]	Almerighi C, et al. 1Alpha, 25-dihydroxyvitamin D3 inhibits CD40L-induced pro-inflammatory and immunomodulatory activity in human monocytes. Cytokine. 2009; 45(3):190–7. [PubMed: 19186073]
[27]	Cynthia Aranow, Vitamin D and the Immune System; J Investig Med. 2011 August; 59(6): 881–886. doi:10.231/JIM.0b013e31821b8755.
[28]	Quinn A, Kosanke S, Fischetti VA, Factor SM, Cunningham MW. Induction of Autoimmune Valvular Heart Disease by Recombinant Streptococcal M Protein. Infect. Immun. 2001; 69(6):4072-4078.
[29]	Martins TB, Veasy LG, Hill HR. Antibody responses to group A streptococcal infections in acute rheumatic fever. Pediatr Infect Dis J. 2006; 25(9):832-7. Proft T, Fraser JD. Streptococcal superantigens. Chem Immunol Allergy. 2007; 93:1-23.
[30]	Davison SC, Allen MH, Mallon E, Barker JN. Contrasting patterns of streptococcal superantigen-induced T-cell proliferation in guttate vs. chronic plaque psoriasis. Br J Dermatol. 2001; 145(2):245-251.
[31]	Chen CL, Wu YY, Lin CF, Kuo C-F, Han CL, Wang S, Chuang W-J, Chen C-Y, Wu J-J, Tsai P-J, Liu C-C and Lin YS; (2018); Streptococcal pyrogenic exotoxin B inhibits apoptotic cell clearance by macrophages through protein S cleavage; Scientific Reports; 6, 26026; doi:10.1038/srep26026.
[32]	Knöll H, Srámek J, Vrbová K, Gerlach D, Reichardt W, Köhler W (December 1991). "Scarlet fever and types of erythrogenic toxins produced by the infecting streptococcal strains". Zentralbl Bakteriol. 276 (1): 94–106. doi:10.1016/s0934-8840(11)80223-9. PMID 1789905.).
[33]	Brosnahan, A.J.; Schlievert, P.M. (December 2011). "Gram-positive bacterial superantigen outside-in signaling causes toxic shock syndrome: Superantigen outside-in signaling". The FEBS Journal. 278: 4649–67. doi:10.1111/j.1742-4658.2011.08151.x. PMC 3165073 . PMID 21535475).
[34]	Holand M et al; Hypogalactosylation of serum IgG in patients with ANCA associated systemic vasculitis; Clin Exp Immunol 2002; 129:183–190).
[35]	Najada AS, Habashneh MS, Khader M. The frequency of nutritional rickets among hospitalized infants and its relation to respiratory diseases. J Trop Pediatr; 2004; 50:364-368.
[36]	Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML. Serum 25- hydroxyvitamin D and the incidence of acute viral respiratory tract infections in healthy adults. PLoS One 2010; 14:1108.
[37]	Berry DJ, Hesketh K, Power C, Hypponen E. Vitamin D status has a linear association with seasonal infections and lung function in British adults. Br J Nutr 2011; 106:1433–40. 17.
[38]	Grant WB. Variation in vitamin D production could possibly explain the seasonality of childhood respiratory infections in Hawaii. Pediatr Infect Dis J 2008; 27:853.
[39]	Ginde AA, Mansbach JM, Camargo Jr CA. Association between serum 25- hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med 2009;169: 384–90.
[40]	Aydin S, Aslan I, Yildiz I, Agachan B, Toptas B, Toprak S, et al. Vitamin D levels in children with recurrent tonsillitis. Int J Pediatr Otorhinolaryngol 2011; 75:364–7.
[41]	Eleftheriou D, Melo M, Marks SD, Tullus K, Sills J, Cleary G, DolezalovaSeza P, Clarissa O, Woo PP et al; (2009); Biologic therapy in primary systemic vasculitis of the young; Rheumatology;48:978–986; doi:10.1093/rheumatology/kep148.
[42]	Marcelo Derbli Schafranski and Giuliano Doretto Campanari Infliximab for Idiopathic Deep Cutaneous Vasculitis Refractory to Cyclophosphamide; International Journal of Vascular Medicine, Volume 2010 (2010), Article ID 951850, 2 pages http://dx.doi.org/10.1155/2010/951850.

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APA Style

Sam Hassan, Farsheed Zakir, Sameer Sajwani. (2018). Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. American Journal of Pediatrics, 4(2), 25-30. https://doi.org/10.11648/j.ajp.20180402.12

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ACS Style

Sam Hassan; Farsheed Zakir; Sameer Sajwani. Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. Am. J. Pediatr. 2018, 4(2), 25-30. doi: 10.11648/j.ajp.20180402.12

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AMA Style

Sam Hassan, Farsheed Zakir, Sameer Sajwani. Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. Am J Pediatr. 2018;4(2):25-30. doi: 10.11648/j.ajp.20180402.12

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@article{10.11648/j.ajp.20180402.12,
  author = {Sam Hassan and Farsheed Zakir and Sameer Sajwani},
  title = {Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report},
  journal = {American Journal of Pediatrics},
  volume = {4},
  number = {2},
  pages = {25-30},
  doi = {10.11648/j.ajp.20180402.12},
  url = {https://doi.org/10.11648/j.ajp.20180402.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20180402.12},
  abstract = {Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.},
 year = {2018}
}

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TY  - JOUR
T1  - Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report
AU  - Sam Hassan
AU  - Farsheed Zakir
AU  - Sameer Sajwani
Y1  - 2018/06/12
PY  - 2018
N1  - https://doi.org/10.11648/j.ajp.20180402.12
DO  - 10.11648/j.ajp.20180402.12
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 25
EP  - 30
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20180402.12
AB  - Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.
VL  - 4
IS  - 2
ER  -

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Author Information

Sam Hassan

Department of Pediatrics, Mediclinic City Hospital, Dubai, United Arab Emirates
Farsheed Zakir

Department of Pediatrics, Mediclinic City Hospital, Dubai, United Arab Emirates
Sameer Sajwani

Department of Pediatrics, Mediclinic City Hospital, Dubai, United Arab Emirates

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APA Style

Sam Hassan, Farsheed Zakir, Sameer Sajwani. (2018). Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. American Journal of Pediatrics, 4(2), 25-30. https://doi.org/10.11648/j.ajp.20180402.12

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ACS Style

Sam Hassan; Farsheed Zakir; Sameer Sajwani. Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. Am. J. Pediatr. 2018, 4(2), 25-30. doi: 10.11648/j.ajp.20180402.12

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AMA Style

Sam Hassan, Farsheed Zakir, Sameer Sajwani. Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report. Am J Pediatr. 2018;4(2):25-30. doi: 10.11648/j.ajp.20180402.12

Copy | Download

@article{10.11648/j.ajp.20180402.12,
  author = {Sam Hassan and Farsheed Zakir and Sameer Sajwani},
  title = {Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report},
  journal = {American Journal of Pediatrics},
  volume = {4},
  number = {2},
  pages = {25-30},
  doi = {10.11648/j.ajp.20180402.12},
  url = {https://doi.org/10.11648/j.ajp.20180402.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20180402.12},
  abstract = {Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.},
 year = {2018}
}

Copy | Download

TY  - JOUR
T1  - Post-Streptococcal Syndrome in a 5-Years Old Boy with Sever Vitamin D Deficiency Only Responding to Monoclonal Antibody: First Case Report
AU  - Sam Hassan
AU  - Farsheed Zakir
AU  - Sameer Sajwani
Y1  - 2018/06/12
PY  - 2018
N1  - https://doi.org/10.11648/j.ajp.20180402.12
DO  - 10.11648/j.ajp.20180402.12
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 25
EP  - 30
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20180402.12
AB  - Despite the reduction in incidence of Group A Streptococcal (GAS) infections in the last few decades its global burden on mortality and morbidity remained significantly high and represent major concerns in many developing countries. These morbidities and mortalities can be serious in immunocompromised individuals. It has been shown for the last two decades that vitamin D plays an important role in the immune system modulation and its deficiency were associated with recurrent and sever infections. Only few literatures were written about the vitamin D deficiency and GAS infections and very scarce about its complications. One of the rarely reported complications of GAS infections is post-streptococcal systemic vasculitis. The association of this complications and the vitamin D deficiency was not reported before. We report for the first time a 5 years old boy presented with sever post-scarlet fever vasculitis with sever vitamin D deficiency, only responded to monoclonal antibody infusion. The presentation was complicated by more than one complications of GAS infection, hence difficult to diagnose initially and found to have sever vitamin D deficiency which we concluded is the causative factor for these complications. On correction of vitamin D level the deranged immunological and other factors causing the vasculitis were corrected subsequent to vitamin D correction. It is therefore recommended to check vitamin D concentration in cases of sever GAS especially in association with its complications such as the systemic vasculitis.
VL  - 4
IS  - 2
ER  -

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