Review Question - QID 105406

This patient is presenting with a fever, a maculopapular rash, and is very ill in the setting of missed childhood vaccinations suggesting a diagnosis of measles (rubeola). Subacute sclerosing panencephalitis (SSPE) is a rare complication of measles.

Measles is caused by the rubeola virus (a paramyxovirus). It presents with a prodrome of cough, coryza, and conjunctivitis with photophobia, followed by the appearance of red spots with blue-white centers on the buccal mucosa known as Koplik spots. Following the disappearance of Koplik spots, a characteristic rash appears (on the head/face that spreads to the trunk and extremities). Subacute sclerosing panencephalitis is a rare, fatal, and progressive, neurodegenerative disease that occurs 7-10 years following measles infection. It is believed to be caused by strains of measles that do not contain the M protein antigen thus allowing a persistent infection. There is no treatment for this condition and it has a very high mortality rate.

Figure A demonstrates the rash seen in measles with the erythematous flat to slightly bumpy appearance. The rash begins on the head and moves to the trunk and extremities.

Incorrect Answers:
Answers 1 & 5: Cataracts, sensorineural deafness, and a patent ductus arteriosus are complications of a congenital rubella infection. Rubella presents with a maculopapular rash, a low-grade fever, and symptoms that usually resolve in 3 days.

Answer 3: Glomerulonephritis is a complication of a streptococcal infection (such as impetigo or pharyngitis) and presents with hypertension, periorbital edema, and dark urine.

Answer 4: Mental retardation is not a known complication of measles. Intellectual disability and self-mutilation may be seen in Lesch Nyhan syndrome caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT) which can cause hyperuricemia and gout.

Bullet Summary:
Subacute sclerosing panencephalitis is a potentially fatal complication of a measles infection.