L’aspirine et ses dangers : syndrome de Reye chez un adulte jeune

doi:10.1016/j.annfar.2013.08.009

Annales Françaises d'Anesthésie et de Réanimation

Volume 32, Issue 11, November 2013, Pages 814-816

https://doi.org/10.1016/j.annfar.2013.08.009 Get rights and content

Résumé

Un homme de 19 ans a été pris en charge pour un coma fébrile dans un contexte de virose et de péricardite automédiquées par Aspirine^® (acide salicylique). L’évolution a été rapidement fatale avec passage en état de mort encéphalique. Sur des arguments anamnestiques, cliniques, radiologiques et anatomopathologiques (biopsie cérébrale), le diagnostic de syndrome de Reye a été retenu, malgré l’absence d’atteinte hépatique.

Abstract

We describe the case of a 19-year-old male diagnosed with Reye syndrome within the context of viral pericarditis and salicylate ingestion. He presented a fatal brain oedema without liver failure. Brain biopsies obtained during a decompressive craniectomy led to the diagnosis.

Introduction

L’admission en réanimation d’un patient présentant un coma fébrile est fréquente. Toutefois, certains comas peuvent rester inexpliqués malgré un bilan clinique et paraclinique exhaustif. Il faut alors savoir envisager des causes rares, notamment le syndrome de Reye (SR). Nous décrivons ici le cas d’un jeune homme de 19 ans, hospitalisé en urgence pour un coma fébrile d’évolution rapidement défavorable, malgré une prise en charge probabiliste large. Le diagnostic de SR, évoqué lors de la recherche étiologique, a pu être confirmé grâce aux arguments anatomopathologiques de la biopsie cérébrale.

Section snippets

Observation

Un jeune homme de 19 ans a été admis en réanimation pour la prise en charge d’un coma fébrile. Dans ses antécédents, on notait une sténose valvulaire pulmonaire, l’absence d’allergie médicamenteuse ou alimentaire. L’anamnèse ne retrouvait aucun voyage récent à l’étranger, aucune conduite addictive.

L’interrogatoire de sa mère indiquait que 15 jours auparavant, il s’était présenté aux urgences de notre hôpital pour une douleur thoracique fébrile. Le diagnostic de péricardite virale avait été retenu

Discussion

Le SR a été décrit chez l’enfant dès 1963 par Reye et al. [1] et chez l’adulte depuis 1975. Il associe le plus souvent une encéphalopathie aiguë métabolique hyperammoniémique entraînant un œdème cérébral majeur à une stéatose hépatique microvésiculaire non inflammatoire avec dysfonction mitochondriale. La conférence de consensus américaine du National Institute of Health de 1984, reprise par le Center of Disease Control en 1985, retient 3 critères diagnostiques : encéphalopathie aiguë non

Conclusion

Nous décrivons un cas de coma fébrile avec évolution défavorable vers la mort encéphalique lié à un syndrome de Reye avec une atteinte hépatique biologique minime. Le diagnostic a été établi lors de la craniectomie décompressive grâce à la biopsie cérébrale. Le SR doit être évoqué devant une hypertension intracrânienne non expliquée par les explorations neurologiques et qui survient dans un contexte d’infection virale récente avec automédication probable.

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There are more references available in the full text version of this article.

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Cas cliniqueL’aspirine et ses dangers : syndrome de Reye chez un adulte jeuneAspirin and its danger: Reye syndrome in young adult

Résumé

Abstract

Introduction

Section snippets

Observation

Discussion

Conclusion

Lancet

Hematol Oncol Clin North Am

Ann Fr Anesth Reanim

Reye syndrome-United States, 1985

MMWR Morb Mortal Wkly Rep

Diagnosis and treatment of Reye's syndrome

JAMA

Reye's syndrome in the United States from 1981 through 1997

N Engl J Med

Reye's syndrome in adults. Diagnostic considerations

Arch Intern Med

Cas clinique
L’aspirine et ses dangers : syndrome de Reye chez un adulte jeuneAspirin and its danger: Reye syndrome in young adult