Which clinical history findings are characteristic of Reye syndrome?

Updated: Apr 02, 2018
  • Author: Debra L Weiner, MD, PhD; Chief Editor: Kirsten A Bechtel, MD  more...
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According to Centers for Disease Control and prevention (CDC) surveillance statistics for 1980-1997, 93% of 1160 patients had at least 1 viral illness in the 3 weeks preceding the onset of Reye syndrome. [4] Illnesses included viral upper respiratory illness or influenza in 73%, varicella in 21%, gastroenteritis in 14%, and other illness with exanthem in 5%. [4] Salicylates were detectable in the blood of 82% of patients. [4]

Influenza B (most common), influenza A, and varicella-zoster virus (VZV) are the viral pathogens most often involved. Parainfluenza, adenovirus, coxsackieviruses A and B, echovirus, Epstein-Barr virus (EBV), rubella virus, measles virus, cytomegalovirus (CMV), herpes simplex virus (HSV), parainfluenza virus, and poliomyelitis virus are less commonly associated. Reye syndrome can occur after vaccination with live viral vaccines.

Abrupt onset of pernicious vomiting occurs 12 hours to 3 weeks (mean, 3 days) after symptoms of viral illness have resolved. Neurologic symptoms usually occur 24-48 hours after the onset of vomiting. Lethargy is typically the first neurologic manifestation. Diarrhea and hyperventilation may be the first signs in children younger than 2 years. Irritability, restlessness, delirium, seizures, and coma occur.

Obtain an appropriate history in any child who presents with symptoms similar to those of Reye syndrome to determine whether an inborn error of metabolism (IEM) should be considered (see diagnostic considerations).

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