Reye's syndrome. A review from the forensic viewpoint.

Reye's syndrome, encephalopathy and fatty change in the liver and other viscera, typically occurs suddenly in infants and children recovering from a viral illness, particularly influenza or varicella. Its rapid clinical course may suggest a drug-related insult and the differential diagnosis includes a variety of toxins. There are grounds for suspicion that exogenous substances--including aspirin--may be cofactors with recent viral illness in the syndrome's pathogenesis. For these reasons, medical examiners may be called upon to rule the diagnosis in or out, to assess the possibility of direct toxic injury, or to document presence or absence of possible cofactors. With these tasks in mind, this review summarizes the diagnostic, pathologic, and laboratory findings of Reye's syndrome and considers the roles of viral infection, heritable predispositions, and exogenous toxins in its causation. It singles out salicylate treatment for special considerations as a possible cofactor, and concludes with a suggested approach to the forensic medical investigation of possible cases of Reye's syndrome.