Reye's syndrome revisitedBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7336.546 (Published 02 March 2002) Cite this as: BMJ 2002;324:546
Outdated concept of Reye's syndrome was used
- M Casteels-Van Daele, professor emeritus general paediatrics and paediatric oncology,
- C Wouters, professor general paediatrics and paediatric rheumatology,
- C Van Geet, professor general paediatrics and paediatric haematology
- Department of Paediatrics, University Hospital Gasthuisberg, Catholic University of Leuven, B-3000 Leuven, Belgium
- Royal Belfast Hospital for Sick Children, Belfast BT12 6BE
- Department of Child Health, Queen's University of Belfast, Belfast BT12 6BE
EDITOR—The paper by McGovern et al is based on a non-specific definition and an outdated concept of Reye's syndrome in spite of recent convincing data relating to this issue.1 Reye's syndrome is no longer a specific clinicopathological entity but a descriptive term covering a group of heterogeneous disorders of infectious, metabolic, or toxic aetiology.2
All symptoms in the first case, including the neurological complications, can be explained by the influenza A infection.2 Moreover, the confusion lasting for only 48 hours might have been the result of using antiemetics in a patient who had been vomiting almost hourly for 24 hours.2 Urine toxicology screening does not exclude this additional complication.
In the second case, exhaustive virological investigations and liver biopsy were not performed, and the metabolic screening is incomplete. In both patients the diagnosis of Reye's syndrome is therefore put forward—in the best case—by default.
We are surprised that McGovern et al ignore the misleading biases in the epidemiological studies suggesting a …