A 2-year-old boy with no chronic medical conditions is brought to the emergency department after he was found unresponsive with vomitus in his mouth. The patient has had muscle aches, cough, rhinorrhea, diarrhea, vomiting, and fever for the past 3 days. His parents gave him aspirin twice daily for symptom control. Vital signs are within normal limits. On examination, the patient is somnolent but withdraws from pain. Pupils are equal in size and reactive to light. Cardiopulmonary examination shows no abnormalities. Hepatomegaly is present. Extremities are well perfused. Laboratory results are as follows: Over the next day, the patient's condition deteriorates and he dies despite supportive care. Examination of the brain would most likely reveal which of the following findings?

Question

A 2-year-old boy with no chronic medical conditions is brought to the emergency department after he was found unresponsive with vomitus in his mouth.  The patient has had muscle aches, cough, rhinorrhea, diarrhea, vomiting, and fever for the past 3 days.  His parents gave him aspirin twice daily for symptom control.  Vital signs are within normal limits.  On examination, the patient is somnolent but withdraws from pain.  Pupils are equal in size and reactive to light.  Cardiopulmonary examination shows no abnormalities.  Hepatomegaly is present.  Extremities are well perfused.  Laboratory results are as follows:  Over the next day, the patient's condition deteriorates and he dies despite supportive care.  Examination of the brain would most likely reveal which of the following findings?

Quizplus · Accepted Answer

Eductional Objective: Reye syndrome should be suspected in a young child with acute liver failure and encephalopathy after receiving aspirin for a virus-induced fever.  Aspirin in this setting is a mitochondrial toxin that leads to hepatic steatosis, hyperammonemia, and diffuse astrocyte swelling (ie, cerebral edema).

A 2-Year-Old Boy with No Chronic Medical Conditions Is Brought