COEXISTENCE OF HEPATITIS-A AND ADULT REYES-SYNDROME

Reye's syndrome is most frequently seen in children but has also been described in adults. This syndrome is usually associated with ingestio n of 5-aminosalicylates (ASA) or infection with influenza A, influenza B, or varicella virus. A case of Reye's syndrome in a 47 year old, pr eviously healthy woman precipitated by ingestion of ASA and acute hepa titis A virus infection is described. Reye's syndrome was diagnosed on the basis of her clinical course, and the presence of hepatic microve sicular steatosis and characteristic electron microscopic changes in t he hepatocyte mitochondria. The diagnosis of hepatitis A was based on higher aminotransferase values than would be expected in Reye's syndro me alone, viral serology including the presence of hepatitis A IgM and the demonstration of hepatitis A virus RNA on liver biopsy by in situ hybridisation. Mitochondrial injury has been demonstrated in acute he patitis A which, in addition to ASA, may have precipitated Reye's synd rome in this patient. The association between hepatitis A and Reye's s yndrome has not been reported before. As hepatitis A virus infection i s not sought routinely in patients with Reye's syndrome, the frequency of this association is unknown.