A 6-year-old boy with no chronic medical conditions is brought to the emergency department due to confusion and intractable vomiting. His symptoms began a few hours ago and have gradually worsened. The patient's mother reports that he contracted a febrile illness from his younger brother 2 days ago. She gave the patient one tablet of an over-the-counter cold medication yesterday, and his fever resolved. While the mother is speaking, the patient lapses into a coma. If a liver biopsy were performed, light microscopy of the specimen would most likely reveal which of the following?

Question

A 6-year-old boy with no chronic medical conditions is brought to the emergency department due to confusion and intractable vomiting.  His symptoms began a few hours ago and have gradually worsened.  The patient's mother reports that he contracted a febrile illness from his younger brother 2 days ago.  She gave the patient one tablet of an over-the-counter cold medication yesterday, and his fever resolved.  While the mother is speaking, the patient lapses into a coma.  If a liver biopsy were performed, light microscopy of the specimen would most likely reveal which of the following?

Quizplus · Accepted Answer

11ec160b_395f_4932_9249_65ebf02361dc_MD0001_00 Children with a febrile illness (eg, influenza, varicella) treated with salicylates (eg, aspirin) are at risk for developing Reye syndrome. It is hypothesized that affected children may have an inborn metabolic error that renders them sensitive to the toxic effects of salicylates, particularly in virus-infected cells. Aspirin in these individuals causes mitochondrial dysfunction, which results in impaired fatty acid metabolism and the two components of Reye syndrome: To avoid the possibility of inducing Reye syndrome, aspirin should not be administered to children except in the management of Kawasaki disease and rheumatologic diseases (eg, juvenile idiopathic arthritis). (Choices A and E) Apoptosis of hepatocytes and periportal mononuclear inflammatory infiltration are microscopic findings seen in viral hepatitis. In contrast to this patient's presentation, hepatic encephalopathy from viral hepatitis would develop gradually. (Choice B) Primary biliary cholangitis is characterized by bile duct destruction and periductal granulomatous inflammation. Hepatic encephalopathy may occur as a late finding of chronic cirrhosis but would not present acutely, as Reye syndrome did in this patient. (Choice C) In congestive heart failure, which would manifest with peripheral edema rather than rapidly progressive encephalopathy, the liver shows centrilobular congestion and, in some cases, centrilobular necrosis. Centrilobular necrosis can also be seen with acetaminophen toxicity, which is unlikely in this patient who received a single antipyretic tablet. Educational objective: Reye syndrome is characterized by liver failure and encephalopathy following salicylate (aspirin) administration in children with a febrile illness. Aspirin-induced mitochondrial dysfunction causes impaired fatty acid metabolism and microvesicular steatosis of the liver.

A 6-Year-Old Boy with No Chronic Medical Conditions Is Brought