Infection with group A beta-hemolytic streptococci (GABHS) is the most common 
bacterial cause of acute pharyngitis and tonsillitis beyond infancy. We report 
on two patients with scarlet fever associated with hepatitis. The patients (boys 
aged 6 and 7 years) both presented with a scarlatiniform rash, dark urine and 
light-colored stools. Laboratory studies revealed elevated liver transaminases 
and negative antibody tests against hepatitis viruses A, B and C, 
cytomegalovirus and Epstein-Barr virus. Both patients were treated with 
antibiotics and recovered completely within a few days. Although the association 
between scarlet fever and hepatitis has been known for many decades, the 
pathogenesis is still unknown. Physicians treating patients with group A 
beta-hemolytic streptococcal infections should be aware of possible hepatic 
involvement.