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Retinal hemorrhages from respiratory symptoms
2%
1/48
Orchitis and infertility
17%
8/48
Progressive neurological deterioration and dementia that is fatal
71%
34/48
Dermatitis herpetiformis
Reactivation in a dermatomal distribution with intense pain
6%
3/48
Select Answer to see Preferred Response
This patient most likely has measles with the classic presentation including cough, coryza (rhinitis), conjunctivitis, and buccal lesions (Koplik spots) followed by maculopapular rash that spreads cranial-caudally but excludes the palms and soles. Subacute sclerosing panencephalitis is a potential complication of certain strains of measles with the M protein, can lead to progressive neurologic complications, and is fatal. Measles is caused by the rubeola virus and classically 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 descending maculopapular rash appears (head/face to trunk to extremities). A serious post-infectious complication is subacute sclerosing panencephalitis (SSPE), a rare, fatal, progressive, neurodegenerative disease that occurs 7-10 years following measles infection. Campos-Outcalt discusses the measles vaccine; children in the United States generally receive their first dose at 12 months of age as part of the MMR immunization. Contrary to common belief, mild upper respiratory illnesses, a history of seizures, non-anaphylactic egg allergy, and asymptomatic human immunodeficiency virus infection are NOT contraindications to measles vaccine. Gutierrez et al. discuss SSPE, the dreaded complication of a measles infection. They note that it has a dismal prognosis, with 5% survival at 5 years. The management of SSPE includes seizure control. Treatment with interferon, ribavirin, and isoprinosine have been studied and appear to show beneficial results. Figure A shows a child with the classic rash seen with measles. Incorrect Answers: Answer 1: Retinal hemorrhages from an intense cough is classically associated with whooping cough from bordetella pertussis. Answer 2: Orchitis and infertility is associated with the mumps. Answer 4: Dermatitis herpetiformis is classically associated with celiac disease and is a pruritic skin lesion. Answer 5: Varicella can reactivate as shingles in a dermatomal distribution that is very painful.
3.4
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