Sir.—The article by Chaves-Carballo et al1 in the October 1990 issue of AJDC proposes criteria for diagnosing hemorrhagic shock and encephalopathy. These criteria are based on the common clinical and pathologic characteristics of 19 patients, nine of whom were studied by the author and 10 of whom were studied by Levin et al.2
We considered these cases when diagnosing hemorrhagic shock and encephalopathy in two patients aged 8 and 3 months. In patient 1, the 8-month-old infant, clinical onset occurred with respiratory arrest. On presentation, both patients were in shock and demonstrated hyperpyrexia. External temperature was 41°C in patient 1 and 39.5°C in patient 2. Metabolic acidosis was present in both patients, with hepatic dysfunction and disseminated intravascular coagulation.
Patient 1 suffered a rapid clinical course before death, which occurred within a few hours after presentation owing to dramatic and generalized uncontrollable hemorrhagic symptoms. Disseminated intravascular coagulation was