1 0 1 8 Editorial correspondence The Journal of Pediatrics December 1994

disease than in group 1 children. Five children in the placebo group had some complications (one had viral pneumonia, two had conjuctivitis) or associated infections (two had gastroenteritis), but there were no complications in the vitamin A-supplemented group.

We believe that normal children need no treatment of this benign and self-limited disease. However, vitamin A might be given on the first day of eruption to shorten the crusting period and protect against complications; it is much cheaper than antiviral treatment. Vitamin A should be given to more children during the incubation period of the disease to be certain about its effect in varicella.

With consideration of the authors' findings, it could be postulated that the role of vitamin A in acute viral diseases may not be related to its absolute deficiency, but rather to its pharmacologic effect.

~;inasi (gzsoylu, MD A. Pinar Cemero~lu, MD

Meral Gftnay, MD Hacettepe University Faculty of Medicine

Department of Pediatrics, Hacettepe Children's Hospital 06100 Ankara, Turkey

9/35/59284

Reply To the Editor."

The observation that vitamin A supplementation may be bene- ficial for children with acute varicella infection is intriguing, and supports the concept that vitamin A supplementation may be ther- apeutic for acute viral infections other than measles, regardless of preexisting nutritional status. Vitamin A is easy to administer and inexpensive, thus making it an attractive agent for the treatment of viral diseases. However, little is known about the pathogenesis of low vitamin A levels during acute viral illnesses. The effects of vitamin A supplementation on clinical illness, viral shedding, and the immune response to viral infections other than measles, and the safety of administration of large doses of vitamin A to children less than 6 months of age have not been well established. Further stud- ies are needed to define these issues, and allow for recommendations regarding the use of vitamin A for common viral infections.

Kathleen M. Neuzil, MD William C. Gruber, MD

Frank Chytil, AID Mildred T. Stahlman, MD

Barney S. Graham, MD, PhD Vanderbilt University School of Medicine

Nashville, TN 37232 9/35/59285

Cardiomyopathy with congenital adrenal hyperplasia To the Editor:

We read with interest the report of a reversible cardiomyopathy in an infant with 21-hydroxylase deficiency, l However, the most

important teaching point for the general pediatrician was not un- derscored. The discovery of bilateral cryptorchidism in any new- born infant should immediately prompt the search for the under- lying cause; female pseudohermaphroditism would be a possible diagnosis. A serum 17-hydroxyprogesterone measurement would then lead to the diagnosis of 21-hydroxylase deficiency, perhaps before the cardiomyopathy had become clinically apparent. All pediatricians should be aware of the significance of this physical finding on a newborn examination.

Robert Listernick, MD Associate Professor of Pediatrics

Division of General Academic Pediatrics Northwestern University Medical School

Chicago, IL 60614 Bernard L. Silverman, MD

Assistant Professor of Pediatrics Children's Memorial Hospital

Division of Endocrinology Northwestern University Medical School

Chicago, IL 60614 9/35/60003

REFERENCE

1. Boston BA, DeGroff C, Hanna CE, Reller M. Reversible car- diomyopathy in an infant with unrecognized congenital adre- nal hyperplasia. J PEDIATR 1994;124:936-8.

Reply To the Editor:

Drs. Listernick and Silverman make a very important teaching point concerning this case. Bilateral undescended testes should be considered "ambiguous genitalia," and a female infant with 21-hydroxylase deficiency should be ruled out. If measurement of the 17-hydroxyprogesterone level had been obtained shortly after birth, our endocrinologists would have been consulted much sooner, and this child's severe episode of adrenal insufficiency might have been avoided.

We chose to focus on the cardiac aspects of this patient because we could find nothing in the literature describing similar findings. Although we would have liked to include a discussion on the im- portance of pursuing bilateral undescended testes in the newborn infant, we elected to omit it in the interest of writing a focused case report. Therefore we welcome this addendum to our article and be- lieve it underscores a very important point for the general pedia- trician.

Bruce A. Boston, MD Department of Pediatrics

Oregon Health Sciences University Portland, OR 97201-3042

9/35/60002