No evidence of immunosuppressive disease; no history of enanthem or morbilliform rash
FRIDAY, Jan. 13 (HealthDay News) -- A fatality from measles with acute respiratory distress syndrome (ARDS), but without rash, has been reported, according to a study published online Jan. 11 in the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.
Julien Lupo, from the Centre Hospitalier Universitaire de Grenoble in France, and colleagues describe a fatal case of measles, with intractable ARDS, without rash, in a 29-year-old woman in France.
The authors report that five days after receiving outpatient care with initiation of an anti-infective agent and oral prednisone for fever, cough, coryza, diarrhea, and weight loss, the patient was admitted to the hospital with persistent illness. Lab tests showed nonregenerative anemia and leukopenia with profound lymphopenia, and chest radiograph revealed bilateral diffuse interstitial infiltrates; further antimicrobial therapy was started. Extensive testing did not find evidence of an underlying immunosuppressive disease; test results indicated an acute viral infection. On day three, severe respiratory failure occurred and the patient was transferred to an intensive care unit. On day six, a broad serological investigation identified isolated immunoglobulin M against measles virus. The patient was treated with ribavirin, corticosteroids, and intravenous immunoglobulin. Although the lymphocyte level returned to the reference range, the respiratory condition did not improve, and the patient died. The measles strain was genotyped as D4, an epidemic strain circulating in France and other parts of Europe. The patient had no history or presentation of enanthem or morbilliform rash, and no documented history of measles vaccination.
"This unusual case underscores the need for physicians to consider the diagnosis of measles, even in the absence of classical clinical features, during measles outbreaks. It also reemphasizes the insufficient vaccination coverage against measles in France," the authors write.