To the Editor,

Dr. Çağ and his colleagues should be congratulated for their success in performing emergency auxiliary partial orthotopic liver transplantation in a six-month-old baby with acute liver failure, which was published recently in the Journal (2010; 52: 662-664).

Reye syndrome (RS) was first described by Reye et al.[1] in Australia in 1963 by morphologic criteria as microvesicular steatosis without inflammation, where aspirin was not introduced. Actually, IRS is an acquired mitochondriopathy[2].

In the authors’ patient, large liver necrosis was observed without microvesicular steatosis. Although mitochondrial studies were not carried out, “the ratio of acetoacetate/beta hydroxy butyrate was found normal”. Further, no evidence of urea cycle disturbance or fatty acid oxidation was shown, which were all incompatible with mitochondriopathy. Striated muscle disturbance was also not mentioned. Therefore, I believe the patient most likely had Reye-like syndrome but not RS.

Şinasi Özsoylu MD

Retired Professor of Pediatrics,

Hematology and Hepatology

E-mail: sinasiozsoylu@hotmail.com