Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
S Bittmann MD
Department of Otolaryngology, University of Jena, Lessingstr. 2, 07743 Jena, Germany
C Wittekindt MD
Department of Otorhinolaryngology/ Head and Neck Surgery, University Clinics Cologne, Kerpener Strasse 62, 50937 Cologne, Germany
V Helmstaedter MD
Correspondence to: Dr V Helmstaedter
Received November 10, 2009
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.