The fallacy of the hemorrhagic shock and encephalopathy syndrome.

Sir. —Chaves-Carballo et al 1 described nine infants with clinical features similar to heatstroke that they diagnosed as hemorrhagic shock and encephalopathy (HSE). An editorial in the same issue focuses on the inconsistencies and perplexities of the mysterious HSE syndrome. 2 During the past 15 years, I recall seeing several fatal cases that were presumptively diagnosed as either HSE or sudden infant death syndrome, but after an investigation of the home, could be diagnosed as heatstroke, exposure to toxic fumes, or both. 3,4 In the cases diagnosed as heatstroke, based on on-site investigations, there was a lack of awareness by some pathologists that exposure of a young infant, like other small mammals, to high environmental temperatures may lead to cardiogenic shock and sudden death. 5 Chaves-Carballo and coworkers 1 discussed the catastrophic clinical features and sparse laboratory data of HSE but failed to mention anything about the home environment of