Measles Mimicking HIV Seroconversion Syndrome: A Case Report

Mahua T Chatterjee; Margaret Coleman; Gary Brook; Daniel McCrea

Disclosures

J Med Case Reports. 2010;4(1):41 

In This Article

Abstract and Introduction

Abstract

Introduction: 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. As a highly infectious disease, identified patients must be isolated in the hospital setting.
Case presentation: A 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.
Conclusion The 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.

Introduction

Measles is a highly communicable acute disease that is caused by the airborne transmission of a paramyxovirus. In its typical form it is characterized by high fever, cough, coryza and conjunctivitis. Koplik's spots are rarely seen but are pathognomonic of disease. The characteristic rash appears several days after the onset of fever. The rash is maculopapular and erythematous, which spreads from the head to the torso and the extremities.

Vaccination against measles, together with improvements in the socio-economic conditions of the population, as well as improved clinical care, has reduced the high mortality rate associated with measles in many countries.[1] In the developed world, the mortality rate from measles among the immunocompetent remains low which is estimated at 1 per 1000 cases. This rises to 100 per 1000 deaths in developing countries, and 300 deaths per 1000 cases in immunocompromised patients. However, 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. Similarly, vaccination coverage rates in many European countries have never reached the target >90% of the population.[3]

With the reappearance of measles in the United Kingdom among the unvaccinated population, or in patients where the vaccine has failed to work, it must be increasingly thought of as a differential diagnosis in any patient presenting with a fever and maculopapular rash.

As with most diagnostic challenges in medicine, measles can present atypically. Here we present an unusual case of measles which was initially identified as human immunodeficiency virus (HIV) seroconversion syndrome.

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