Acute Measles Encephalitis: Primary Encephalitis or Postinfectious Encephalomyelitis

Abstract

Measles remains an important vaccine-preventable disease, particularly in the developing countries. The disease at times is accompanied by numerous complications in the backdrop of malnutrition. Of these, the neurologic complications are the most devastating. The neurological involvement in measles encompasses at least four distinct conditions, namely, primary measles encephalitis (PME), acute postinfectious measles encephalomyelitis (APME), measles inclusion body encephalitis, and subacute sclerosing panencephalitis. The pathogenesis of PME or APME continues to be enigmatic with both immune mechanism and direct viral invasion being variously incriminated. We report a fatal case of measles encephalitis in a 3.5-year-old child, with a slow and indolent course over a 1-month period with laboratory evidence of acute measles infection without any demonstrable virus in the body fluid at the time of the encephalitis with typical magnetic resonance imaging features.