Group A Streptococcal Postvaricella Osteomyelitis

Osteomyelitis as a complication of varicella has been rarely reported. We report two individual cases of postvaricella osteomyelitis in which group A beta-hemolytic Streptococcus was implicated. In the first case group A beta-hemolytic Streptococcus was isolated from blood cultures and bone aspirate cultures from the femoral metaphysis. The second case of postvaricella osteomyelitis involved the distal fibula and was diagnosed by characteristic radiographic changes in the distal fibula, a positive bone scan, purulent varicella lesions that contained group A beta-hemolytic Streptococcus, and a prompt response to penicillin therapy. These cases have implications for the choice of appropriate antimicrobial therapy in the treatment of osteomyelitis complicating varicella.