S5625 Hepatitis as a Complication of Streptococcal Pharyngitis in an Adult

Introduction: Complications of streptococcal pharyngitis can manifest differently between pediatric and adult populations. Here we present a case of a 31-year-old man with acute Streptococcus pyogenes pharyngitis presenting with isolated hepatitis, as evidenced by jaundice, hyperbilirubinemia, and transaminitis. While acute rheumatic fever, post-streptococcal glomerulonephritis, and peritonsillar abscess are well-documented complications in both age groups, reports of hepatitis associated with Streptococcus pyogenes infection are primarily described in children. Laboratory investigations excluded common etiologies of infectious hepatitis, including HBV, HCV, Borrelia, Leptospirosis, and blood parasites. While the literature predominantly reports Strep Pyogenes-induced hepatitis in children, this case highlights the importance of considering this complication in adult patients presenting with atypical symptoms following streptococcal pharyngitis. Case Description/Methods: A 31-year-old man presented with fever, sore throat, vomiting, and dark-colored urine. Exam revealed icterus and pharyngeal erythema. Labs showed leukocytosis, elevated transaminases (alanine aminotransferase 164 U/L, aspartate aminotransferase 102 U/L), total bilirubin (6.6 mg/dL), and CRP (256.4 mg/L); urinalysis was positive for bilirubin and blood. Group A Streptococcus (GAS) was detected by throat PCR. Viral and autoimmune hepatitis workup was negative. Imaging showed no hepatobiliary abnormalities. The patient remained hemodynamically stable, improved with antibiotics, and was discharged with normalization of liver function. Discussion: Acute hepatitis typically presents with systemic symptoms and elevated liver enzymes. In this case, a patient with streptococcal pharyngitis developed significant hepatic dysfunction, despite negative viral and autoimmune workup and absence of classic scarlet fever features. While GAS-associated hepatitis is rarely reported—primarily in pediatric cases with scarlatiniform rash—this adult case lacked those findings, suggesting hepatic involvement may occur independently of toxin-mediated syndromes. This expands the clinical spectrum of GAS-related complications and highlights the need to consider GAS in the differential diagnosis of unexplained hepatitis.