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Reye's syndrome developing in an infant on treatment of Kawasaki syndrome
Chih-Ming Wei1, Huey-Ling Chen, Ping-Ing Lee
1Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Insights
High-dose aspirin therapy for Kawasaki syndrome in an infant led to Reye's syndrome. Early diagnosis and liver biopsy confirmed the condition, with complete recovery and no recurrence.
Area of Science:
- Pediatrics
- Toxicology
- Gastroenterology
Background:
- Kawasaki syndrome is treated with high-dose aspirin to prevent coronary artery complications.
- Standard treatment protocols involve escalating aspirin doses followed by maintenance therapy.
Observation:
- A 10-month-old infant diagnosed with Kawasaki syndrome received high-dose aspirin therapy.
- The infant developed acute symptoms including lethargy, hepatomegaly, coagulopathy, and hyperammonemia.
Findings:
- Liver biopsy findings were consistent with Reye's syndrome, a rare but serious condition.
- The infant's symptoms resolved completely with supportive care, and no recurrence was observed.
Implications:
- This case highlights a potential adverse effect of high-dose aspirin in infants with Kawasaki syndrome.
- Clinicians should maintain a high index of suspicion for Reye's syndrome in infants presenting with similar symptoms during aspirin therapy.
Abstract:
Aspirin is commonly used as an anti-inflammatory therapy for Kawasaki syndrome. Early initiation with high dose aspirin (80 to > 100 mg/kg per day), followed by low-dose therapy at the afebrile stage, has been often used to reduce morbidity and mortality in coronary complications. We report a 10-month-old infant who was diagnosed with Kawasaki syndrome. Sudden onset of poor activity, poor appetite, lethargy, tachycardia, tachypnea, hepatomegaly, increased AST/ALT, coagulopathy and hyperammonemia developed 3 days after the high-dose aspirin therapy. His histopathological and ultrastructural findings from the liver biopsy were compatible with Reye's syndrome. He recovered completely, and there was no recurrence.
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