A 4-year-old child develops vesicular lesions in different stages (papules, vesicles, crusts) simultaneously over the trunk and face, accompanied by fever. The child had been given aspirin for fever. On day 6, he becomes confused and develops hepatomegaly. Which complication has most likely developed?

• A Pneumonia
• B Secondary bacterial infection
• C Encephalitis
• D Reye syndrome ✓

Explanation

Varicella (chickenpox) with crops of lesions in different stages on the trunk is classic. Aspirin use during varicella is strongly associated with Reye syndrome, which presents with encephalopathy and hepatic dysfunction after the acute illness. This is why aspirin is contraindicated in children with varicella or influenza. Encephalitis and pneumonia are varicella complications but do not fit the aspirin association and hepatomegaly.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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