Group A streptococcal subdural empyema as a complication of varicella.

Group A beta-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.