Reye’s syndrome is characterised by acute non-inflammatory encephalopathy and fatty degeneration of the liver. The exact aetiology of the syndrome is unknown, but there is an association with viral infections and the use of aspirin. There has been a sharp decline in the incidence of Reye’s syndrome; the reasons for this are unclear, but may be due, in part, to the declining use of aspirin in children and to improvements in the diagnosis of underlying inborn errors of metabolism. The use of the term ‘Reye-like’ has been advocated among experts in the field. We report the case of a child with Reye-like syndrome complicated by pancreatitis.