Abstract
IntroductionMeasles is on the rise in the United Kingdom and must be considered in the differential diagnosis of any patient presenting with fever and rash. As a highly infectious disease, identified patients must be isolated in the hospital setting.Case presentationA 28-year-old Polish woman presented ill to the accident and emergency department of a district general hospital. She had painful genital ulceration, oral soreness, fever, and a facial rash. She became hypoxic within 24 hours of presentation and began to tire, thus requiring noninvasive ventilation. Her respiratory symptoms were out of proportion to the findings of her chest radiograph, which remained virtually normal. Human immunodeficiency virus seroconversion syndrome complicated by Pneumocystis carinii pneumonia was high among the differential diagnoses. She was given cotrimoxazole, high-dose steroids, broad spectrum antibiotics, and anti fungal cover.Human immunodeficiency virus polymerase chain reaction came back as negative and her symptoms resolved within 10 days of presentation. She was taken off all treatment and discharged home feeling well. Serological measles was confirmed as part of a viral screen, but its clinical suspicion was low.ConclusionThe presentation of measles in this patient was unique and atypical. With its incidence rising in the United Kingdom, measles must be increasingly considered as a differential diagnosis in patients presenting with fever and rash.
Highlights
Measles is on the rise in the United Kingdom and must be considered in the differential diagnosis of any patient presenting with fever and rash
With its incidence rising in the United Kingdom, measles must be increasingly considered as a differential diagnosis in patients presenting with fever and rash
The incidence of measles is rising in the United Kingdom and in Europe [2]. This leads to concerns that endemic measles may reemerge. This is largely attributable to the vaccination controversy regarding a potential link between the combined measles, mumps and rubella (MMR) vaccine and autism
Summary
Measles is a highly communicable acute disease that is caused by the airborne transmission of a paramyxovirus. Case presentation A 28-year-old Polish woman who has been residing in the United Kingdom for four years presented to the accident and emergency department of a district general hospital with severe ulceration of the perineal area, dysuria, soreness of the mouth, fever, non-productive cough, and a facial rash Her illness started two weeks prior to presentation with a flu-like illness and sore throat for which she was prescribed with antibiotics. On day 4 of admission her facial rash had resolved and her oxygenation began to improve (PO2 13.1 Kpa, Fio at 40%) Her blood tests revealed negative HIV PCR, negative ASO titre, normal complement levels, normal immunoglobulin levels, and negative autoimmune screen. A vaccination history of our patient revealed that she had completed all her childhood vaccines in Poland
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