Calcium concentration in water varied substantially from different sources in the USA and Canada. Bottled waters presented with concentrations of calcium covering a very large range. Certain tap and bottled waters present with concentrations of calcium sufficient to exhibit a deleterious effect on bisphosphonate treatment. Alternatively, certain waters may be used as a source of calcium that may provide over 40% of the recommended daily intake for calcium.

Group A streptococci, also known as Streptococcus pyogenes, is a common cause of infection in the pediatric population. Recently, the incidence of streptococcal toxic shock syndrome, a serious and often deadly manifestation of group A streptococci infection, has increased. Streptococcal toxic shock syndrome often presents with complaints of musculoskeletal pain, which frequently leads to early involvement of an orthopaedic surgeon. In this case report, we present a 5-year-old child who presented with a septic arthritis of the knee, whose final diagnosis was streptococcal toxic shock syndrome. A review of the literature and the aspects of this case report emphasize the emergent nature of streptococcal joint infections and the judicious use of orthopaedic intervention in such patients.

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