S Bittmann, C Wittekindt, V Helmstaedter

Abstract

We present the case of a 4-year-old boy who was born with a large cervicofacial lymphatic malformation. It was partially resected in the first year of life and treated with Picibanil/OK-432 injections at the age of three because of recurrence. Eight months later the boy developed a fulminant streptococcal toxic shock syndrome with cardiac arrest. After resuscitation, high dose intravenous antibiotic therapy and artificial ventilation for 2 weeks, he remained with an extensive hypoxic brain damage. As Picibanil/OK-432 is a preparation of lyophilized, low virulence group A Streptococcus pyogenes cells of human origin, the question of a causative relationship for the tragic outcome arises. We therefore report the clinical course and discuss the action and possible side effects of Picibanil/OK-432.