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Case Reports
. 2015 Sep 23:2015:bcr2015211054.
doi: 10.1136/bcr-2015-211054.

Atypical measles syndrome in adults: still around

Cléa Melenotte  1 , Nadim Cassir  1 , Laurent Tessonnier  2 , Philippe Brouqui  1
Affiliations
Case Reports

Atypical measles syndrome in adults: still around

Cléa Melenotte et al. BMJ Case Rep. .

Abstract

Measles, a vaccine-preventable disease, is currently responsible for worldwide outbreaks mainly due to the failure to maintain high coverage of childhood immunisation. Atypical measles syndrome was first described in the 1960s in association with the inactivated measles vaccine. We report a case of atypical measles syndrome in a 29-year-old man without previous measles immunisation. He presented with fever, shortness of breath and a purpuric rash. Radiological investigations allowed the diagnosis of severe nodular pneumonia. Positive PCR in nasal and pharyngeal samples, and positive serology for a primary infection confirmed measles diagnosis. Both clinical symptoms and pulmonary nodules regressed spontaneously, whereas mediastinal lymph nodes increased and persisted up to 3 months after the primary infection. Physicians should be aware of the atypical measles syndrome presentation in order to limit the delay of diagnosis, to avoid unnecessary investigations and to prevent the potential spread of this infectious disease.

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Figures

Figure 1
Figure 1
(A) Maculopapular and purpuric rash affecting the trunk, neck, arms and legs; (B) purpuric exanthema affecting the palm and soles.
Figure 2
Figure 2
Positron emission tomography: mediastinal, cervical and coeliac lymphadenopathy uptake, pulmonary bilateral nodules and areas of homogeneous increased uptake in the spleen.
Figure 3
Figure 3
Control fluorodeoxyglucose positron emission tomography CT (FDG PET-CT) scan at 3 months: regression of cervical, coeliac lymph nodes and spleen uptake but a highly FDG uptake in enlarged mediastinal lymph nodes. Pulmonary nodules showed faint uptake and wound glass aspect.
Figure 4
Figure 4
Comparison of Maximum Intensity Projection (MIP) at diagnosis, and follow-up at 3 months and 15 months.
See this image and copyright information in PMC

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