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Old 09-11-2012
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Arrow Belindalimm Daily Questions: Pathology #7

A 4-year-old girl is brought to the emergency department because of a very itchy rash showing lesions in a variety of stages. Many lesions are vesicular, with reddened skin around them. Five days later, pernicious vomiting, lethargy progressing to coma, and hepatomegaly develop. A liver biopsy specimen would likely show which of the following?

A. Hemosiderin
B. Microvesicular steatosis
C. Normal histology
D. Periodic acid-Schiff(PAS)-positive cytoplasmic granules
E. Rhodamine-positive cytoplasmic granules
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Old 09-11-2012
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D...........???????????
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Old 09-11-2012
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Default Reye's syndrome

Bbbb.............aspirin induced liver failure

kids should not be given aspirin except in Kawasaki dx
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Quote:
Originally Posted by blade View Post
Bbbb.............aspirin induced liver failure
Did I miss anything...cos I didn't see any medication used in the question..
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Old 09-11-2012
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Did I miss anything...cos I didn't see any medication used in the question..

most times before patients present to hospital,parents must have tried using NSAID at home to treat pain but they will not tell you.
thats my deduction
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Old 09-11-2012
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Quote:
Originally Posted by belindalimm View Post
A 4-year-old girl is brought to the emergency department because of a very itchy rash showing lesions in a variety of stages. Many lesions are vesicular, with reddened skin around them. Five days later, pernicious vomiting, lethargy progressing to coma, and hepatomegaly develop. A liver biopsy specimen would likely show which of the following?

A. Hemosiderin
B. Microvesicular steatosis
C. Normal histology
D. Periodic acid-Schiff(PAS)-positive cytoplasmic granules
E. Rhodamine-positive cytoplasmic granules
I would go with B, as it seemd to be as Reyes Syndrom.
A is associated with hemochromatosis
D with a 1-anti trypsin deficiency
E with wilson disease
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Quote:
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most times before patients present to hospital,parents must have tried using NSAID at home to treat pain but they will not tell you.
thats my deduction
True but before we make a diagnosis we take history....We never assume things.And these questions are made the way that enough info is given in the stem.I was asking cos I don't even see a hint to any medication or any prior medical treatment in the question.
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Originally Posted by Doc4Step1 View Post
True but before we make a diagnosis we take history....We never assume things.And these questions are made the way that enough info is given in the stem.I was asking cos I don't even see a hint to any medication or any prior medical treatment in the question.

Sorry..........
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History suggests chickenpox and aspirin can cause life threatening complication Reyes syndrome when used

Microvesicular steatosis
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Old 09-12-2012
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Thumbs Up REYES Syndrome

* Encephalopathy
*Microvesicular fatty change
*Transaminase elevation
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Old 09-12-2012
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Default Yes, the answer is Microvesicular steatosis

Since the kid has skin rash indicating chicken pox, and later on she develops hepatomegaly and progressive coma, all of these give us a clue of Reye's syndrome, which occurs in children with viral infection followed by aspirin use. The histological changes in liver in this syndrome is the fatty change of liver cell, induced by aspirin damage to liver mitochondria. The exact mechanism is still unclear.
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Old 09-30-2012
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Yes.. It must be Reyes syndrome.. Characterized by microvesicular fatty change. Aspirin metabolites leads to defective b oxidation by reversible inhibition of mitochondrial enzyme.
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