Sir.—Applebaum and Thaler, in their article in the March 1977 issue of the Journal entitled "Reye Syndrome Without Initial Hepatic Involvement" (131:295, 1977), described a case of Reye's syndrome with encephalopathy and initially normal results from liver function tests. Four days after the onset of coma, findings from the liver function tests had become markedly abnormal and a liver biopsy specimen obtained at that time was also abnormal.
The purpose of this letter is to report a patient with encephalopathy due to Reye's Syndrome in whom the initial liver biopsy specimen was normal on both light and electron microscopy. The patient was a 13-year-old girl transferred to Long Island Jewish-Hillside Medical Center with a one-day history of coma. Initial laboratory data included abnormal results from liver function tests and elevated serum ammonia levels. A percutaneous liver biopsy specimen obtained on admission was normal. The patient was treated for Reye's