Reye's syndrome in three siblings. Association with type A influenza infection

Reye's syndrome occurred simultaneously in three siblings. All had characteristic changes in liver histology ascertained by light and electron microscopy. The two patients with the most severe disease also had serum that caused marked stimulation of mitochondrial state 4 respiration in vitro. Histocompatibility locus antigen typing showed that no unique haplotypes were shared by all three children. There was no evidence of exposure to aflatoxins, pesticides, or other substances that have been previously postulated to be associated with Reye's syndrome. Influenza A/Brazil/11/78-like virus was isolated from one patient, and all three patients had a fourfold or greater rise in hemagglutination-inhibiting antibody to H1N1 influenza virus.