Acute-on-Chronic Liver Failure Triggered by Streptococcus pyogenes Superinfection from a Mosquito Bite: A Case Report

Introduction Global climate change has led to an increase in mosquito populations across Europe, a factor that is often overlooked in clinical practice. This case underscores the emerging health risks posed by indirect consequences of global warming, particularly for patients with pre-existing liver disease.

Case Report A 43-year-old male with known cirrhosis presented to a peripheral hospital following a fall at home, with complaints of chills, severe myalgia, and fever (39.2°C). Physical examination was unremarkable, but laboratory results revealed infection, thrombocytopenia, and microcytic anemia. Ultrasound confirmed cirrhosis, while a CT scan failed to identify an infectious focus. The patient suffered a tonic-clonic seizure on the day of admission, followed by a marked increase in bilirubin and inflammatory markers, prompting transfer to a hepatology unit.

Clinical examination revealed a superinfected bite wound on the right shoulder, reported as a mosquito bite sustained four weeks earlier. The wound, characterized by intractable pruritus and intermittent purulent discharge, was identified as the likely entry point for infection. Blood cultures confirmed Streptococcus pyogenes infection. Despite antibiotic therapy, the patient developed acute-on-chronic liver failure (ACLF) with coagulopathy and acute kidney injury. PET-CT revealed enhanced FDG uptake at the bite site.

Conclusion This case highlights the potential for superinfected mosquito bites to cause severe infections, particularly in immunocompromised patients with liver cirrhosis. As global warming accelerates the spread of mosquitoes in temperate climates, healthcare providers must remain vigilant for atypical infections contributing to ACLF.

Publication History

Article published online:
20 January 2025