An Extremely Rare Case of Sequential Onset of Streptococcal Toxic Shock Syndrome and Kawasaki Disease Following Varicella Infection in a 2.5-Year-Old Girl

Varicella is a common viral disease of childhood that is usually benign and self-limiting, but it can lead to rare complications, including streptococcal toxic shock syndrome (STSS) and Kawasaki disease (KD). The simultaneous or sequential occurrence of these 2 complications after varicella has been reported very rarely. A 2.5-year-old girl presented with fever, swell ing, and neck erythema 5 days after varicella infection and a history of ibuprofen use. She was admitted with a diagnosis of cellulitis. Despite initial antibiotic therapy, the patient’s clini cal condition rapidly deteriorated, and she developed shock, thrombocytopenia, organ failure, and pleural effusion. The patient was transferred to the pediatric intensive care unit, intubated, and received Interavenous Immunoglobulin (IVIG). Blood culture revealed beta-hemolytic Streptococcus group A, confirming the diagnosis of STSS. After recovery and discharge from the hospital, the child presented again with fever and peeling fingertips and was admitted with suspicion of KD. Echocardiography revealed coronary artery ectasia, and she received IVIG again. The ectasia resolved on subsequent follow-up. This is one of the rarest cases of sequen tial occurrence of STSS and KD after varicella infection. Clinical attention to unusual compli cations of varicella, timely diagnosis, and appropriate treatment are essential in preventing severe and long-term outcomes in pediatric patients.

Cite this article as: Khodabandeh M, Gorji M, Olfat M, Kahdouei MT. An extremely rare case of sequential onset of streptococcal toxic shock syndrome and Kawasaki disease following varicella infection in a 2.5-year-old girl. Turk Arch Pediatr. Published online December 29, 2025. doi:10.5152/ TurkArchPediatr.2025.25147.