Case history
Case history
A 17-month-old previously healthy but unimmunized child develops fever, malaise, irritability, and upper respiratory symptoms, including cough, runny nose, and conjunctivitis, that worsen over several days. The fever increases gradually up to 103°F to 104°F (39°C to 40°C) over several days and the cough worsens. Photophobia is present. Whitish lesions on erythematous buccal mucosa are visible at this time. Two days later, an erythematous, maculopapular rash appears on the head and spreads from head to toe over the next 3 days. The rash takes on a brownish coloration and confluent appearance over the next few days. The fever resolves on the third day of the rash, which persists for about a week as does the cough.
Other presentations
Modified measles occurs in partially immune individuals. It has a shorter prodromal period, Koplik spots are rare, and the rash progresses similarly to typical measles but does not coalesce. Unusual manifestations of measles include pneumonia, otitis media, myocarditis/pericarditis, and encephalitis. Measles is more severe in immunocompromised and poorly nourished individuals.
Atypical measles occurs in individuals who have been immunized previously and are exposed to wild-type measles. Most cases occur in those who received killed measles vaccine. The onset is acute, with high fever, headache, abdominal pain, myalgia, and dry cough. Coryza and conjunctivitis are not prominent and Koplik spots are rare. The rash, unlike that of natural measles, begins in the extremities and proceeds to the head. It may be especially prominent on the wrists and ankles and includes the palms and soles.[1]
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