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Specialty conference: Reye's syndrome complicated by Ondine's curse.

MYRON LIEBHABER, MD: We are presenting a patient with hepatic failure and encephalopathy associated with loss of central nervous system (CNS) control of ventilation during sleep. The patient, a 41⁄2/2-year-old boy, was well until seven days before admission. What appeared to be a varicella eruption developed, with a vesicular-papular rash beginning on the face and extending over the thorax. He was seen by a physician, given diphenhydramine hydrochloride (Benadryl®) for the itching and remained asymptomatic for two days. On the third day, after the eruption had crusted, a temperature of 105 OF (40.6°C) developed, with vomiting and dehydration. The patient was admitted to Sacred Heart Hospital at Hanford, California, which is in the San Joaquin Valley. He was found to be lethargic with 10 percent dehydration. The laboratory workup showed normal cerebral spinal fluid values with a negative Gram stain, normal levels of protein and glucose. The only abnormal findings were a serum glutamic oxalic transaminase (SGOT) value that was