Review Question - QID 109665

The child in this vignette presents with progressive lethargy and vomiting following a likely ingestion of aspirin during a febrile illness, consistent with Reye syndrome. In this condition, acute changes such as microvesicular steatosis can be seen in the microscopic liver architecture.

Reye syndrome is characterized by hepatoencephalopathy secondary to aspirin ingestion in children. It is caused by aspirin metabolites that inhibit mitochondrial enzymes, thereby decreasing beta-oxidation in the liver. This manifests clinically with hepatomegaly and fulminant liver failure. Histologically, the liver may demonstrate microvesicular steatosis, which is characterized by small intracytoplasmic liposomes within hepatocytes that do not distort the hepatocyte nucleus.

Incorrect Answers:
Answer 2: Macrovesicular steatosis is characterized by hepatocyte engorgement by large fat globules that are typically big enough to displace the hepatocyte nucleus. Two of the most common causes of macrovesicular steatosis include alcoholic fatty liver disease and non-alcoholic fatty liver disease.

Answer 3: Hepatocyte necrosis with ballooning degeneration is a form of hepatocyte apoptosis in which the cells swell prior to undergoing apoptosis. It can be associated with multiple etiologies including acute viral hepatitis.

Answer 4: Macronodular cirrhosis refers to large liver nodules separated by wide irregularly distributed scars. It is commonly associated with viral hepatitis.

Answer 5: Micronodular cirrhosis refers to small uniform liver nodules separated by thin scars. It is commonly associated with alcoholic fatty liver disease. Other causes of micronodular cirrhosis include hemochromatosis and Wilson disease.

Bullet Summary:
Reye syndrome is characterized histologically by microvesicular fatty changes including intra-cytoplasmic fat globules without displacement of the hepatocyte nucleus.