This is a 2 year old female who presented with fever and inability to bear weight.  The peripheral blood showed leukopenia and thrombocytopenia. Granulocytes showed a left shift with reactive features. Micro-organisms in the form of cocci in pairs and short chains are seen within the cytoplasm of some of the inflammatory cells. These findings correlated with Blood culture which was positive for Streptococcus pyogenes (Group A). In the context of a toxic-appearing child and a positive blood culture, the findings were most consistent with bacterial infection and sepsis.