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Mitral valve disease
6%
2/35
Glomerulonephritis
3%
1/35
Hearing loss
23%
8/35
Encephalitis
66%
23/35
Recurrent dermatomal rash
0%
0/35
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This patient's clinical presentation is consistent with measles (rubeola), which can be complicated by subacute sclerosing panencephalitis. Measles is caused by a paramyxovirus and is most common in areas with low measles vaccination rates. It typically presents with a prodrome of low-grade fever and malaise with the "3 C's:" cough, coryza (erythematous mucous membranes), and conjunctivitis. Grey-white spots on the buccal mucosa, termed Koplik spots, are usually present early in the disease course, but disappear by the time the classical measles rash appears. The classical rash is maculopapular, spreads from the face to the trunk and limbs, and spares the palms and soles. Subacute sclerosing panencephalitis is the most dangerous complication of measles infection and is thought to occur in 1:2000 cases. Moss et al. discuss the feasibility of measles eradication. They note that measles is a good candidate for eradication, because it has no non-human reservoir, there are accurate diagnostic tests, and there are effective vaccines. Currently, the challenge to eradication is not scientific or epidemiologic, but rather political and financial. Garg reviews subacute sclerosing panencephalitis, which typically presents 5-15 years after initial measles infection. Clinical manifestations include seizures, myoclonic jerks, cognitive decline, and changes in vision. There is currently no treatment for this condition, however several oral or intrathecal medications may prolong survival. Measles vaccination is the most effective method for prevention. Figure A shows the typical maculopapular appearance of the measles rash. Incorrect Answers: Answer 1: Mitral valve disease is a complication of rheumatic fever, which typically presents with joint pain, cardiac disease, subcutaneous nodules, and chorea. Answer 2: Glomerulonephritis is a complication of scarlet fever, which typically presents with a sore throat and erythematous tongue. Answer 3: Hearing loss is a complication of meningitis, which typically presents with neck stiffness. Answer 5: Recurrent dermatomal rash (shingles) is a complication of chicken pox (varicella), which typically presents with a vesicular rash.
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