Sir.—In their report describing three infants with adenovirus-associated Reye's syndrome, Edwards et al1 suggest that this group of viruses may be a common cause of Reye's syndrome in infancy. In addition, the authors point out several characteristics of "Reye's syndrome" in infants that are not as commonly seen in older children: severe hypoglycemia, seizures, relatively mild hepatic mitochondrial changes, and very poor outcome. Although a role of influenza and varicella viruses in the origin of Reye's syndrome in older children is clear, if poorly understood, the syndromic differences pointed out by Edwards et al and the fact that classic Reye's syndrome has not been associated with adenovirus in older children raise the question whether the adenovirus-associated disease they report may have a different pathophysiology than influenza- or varicella-associated Reye's syndrome.
We and others (B. Taubman, D.E.H., R.I.K., unpublished data)2-4 have documented that defects of fatty acid metabolism
KELLEY RI, COATES PM, HALE DE, STANLEY CA. Metabolic Disorder Possible Cause of Reye's Syndrome. Am J Dis Child. 1986;140(4):328-329. doi:10.1001/archpedi.1986.02140180062019