Sir.—The article by Pichichero and McCabe (Am J Dis Child 132:1097-1099, 1978) that described a 13-year-old girl with recurrent Reye's syndrome was most interesting. They suggest that this is the first report of a case of recurrent Reye's syndrome where other diagnostic possibilities have been considered and systematically eliminated. The inherent difficulties in making a so-called clinical diagnosis in Reye's syndrome and, in particular, in such an atypical course as recurrent Reye's syndrome are demonstrated by this report.
First, the authors cite "personal communication, University of Colorado Medical Center, Virology Laboratory" as evidence that an influenza B epidemic was present in the community. Although influenza B virus was not isolated from the child on either occasion, serological evidence, albeit less substantial, may have given more credibility to a clinical diagnosis of Reye's syndrome. Second, at no point do the authors make mention of SGPT values or serial creatine phosphokinase