A 7-year-old patient presents with abrupt onset of fever, chills, malaise, muscular aching, headache, and nasal stuffiness. The patient is taking two baby aspirin every 6 hours for fever, muscle aches, and headache. Which of the following complications is the patient most at risk for?

• A. Iron deficiency anemia
• B. Diarrhea
• C. Reye's syndrome
• D. Urinary tract infection

Answer: (C)

In children, using aspirin during a viral illness markedly raises the risk of Reye's syndrome, a sudden, life-threatening encephalopathy with hepatic dysfunction. The mechanism involves aspirin-induced mitochondrial injury in liver cells during viral infection, leading to fatty changes in the liver, impaired energy metabolism, and elevated ammonia. This combination can cause rapidly progressive brain edema and altered mental status, with symptoms such as vomiting, confusion, seizures, and coma. The scenario describes a child with fever and viral-type symptoms who is taking aspirin for fever and aches, which places him at high risk for this complication. The key clinical point is to avoid aspirin for fever or pain in children and to use alternatives like acetaminophen or ibuprofen, while watching for signs of liver dysfunction or neurological changes. Other options listed don’t have the same established link to aspirin in the setting of a viral illness.