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Moderate TRIB1 mononuclear and polymorphonuclear infiltrates were present within the portal tracts but without destruction of the limiting plate and bile ducts. Major alterations were located within the hepatic lobules (zones 1, 2 and 3). Hepatocytes exhibited severe mixed micro-macrovacuolar steatosis associated with numerous lytic necrosis areas and apoptotic bodies. The proliferation index evaluated with anti-Ki67 antibody was low (i.e. 5�C10% of hepatocytes). Anti-active caspase 3 was positive on up to 50% of hepatocytes, highlighting a massive apoptotic process. In muscle, enzymatic spectrophotometry measurements of the individual respiratory chain complexes revealed no decrease of complex I�CV activity. A screen for mitochondrial DNA deletion and common mutations (m.3243A>G, m.8344AMK-2206 concentration Mitochondrial DNA quantification, performed by quantitative RT-PCR, showed no depletion (152% of age-matched controls). Moreover, manifestations of Reye-like syndrome usually occur before the age of 3?years [13]. The pathological findings were highly compatible with a RS in a patient who presented with a laboratory-confirmed acute H3N2 influenza A virus infection treated with aspirin. In addition, all CDC definition criteria of RS were fulfilled [2]. A low cerebrospinal fluid leukocyte count was not demonstrated because a cerebrospinal fluid tap test was not performed. Furthermore, additional criteria that may help to confirm the diagnosis were present in our case: age http://www.selleckchem.com/products/pci-32765.html virological and biochemical findings, together with the epidemiological context, unambiguously demonstrate that our patient presented with a RS from which he died. Written authorization has been obtained from the parents of the patient. This recent case highlights that the prescription of aspirine or aspirin-containing medication to patients presenting with fever in the context of febrile illness compatible with viral infection such as influenza virus infection must be proscribed. In the early 1980s in the USA, warnings to physicians were associated with a clear decrease of RS [14]. A similar tendency was observed in the UK, with incidences varying from 0.3 per 100?000 in 1985�C86 to 0.1 per 100?000 in 1990�C91 [15,16]. No comparative data were available in France; however, in 1995�C1996, the RS incidence was 0.08 per 100?000, in the same range as those in the USA and the UK [17]. We believe that the same warnings should be reiterated in European countries to avoid an increase in the incidence of RS in the current context of the novel A/H1N1 influenza virus pandemic.