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Patient case: Measles

Patient case: Measles

Discussion

A 6-year-old unvaccinated boy is brought to the pediatric clinic with a four-day history of high fever, cough, runny nose, and red eyes. His parents report that he initially developed flu-like symptoms, but over the past 24 hours, a red, blotchy rash started on his face and has since spread to his neck, trunk, and arms. They also noticed small white spots inside his mouth.

On examination, the child appears ill and irritable, with a temperature of 39.5°C (103.1°F). He has conjunctivitis, nasal congestion, and a dry cough. A widespread maculopapular rash is present, which is more prominent on the face and upper body. Inspection of his oral mucosa reveals small, white lesions on a red base near his molars (Koplik spots).

A clinical diagnosis of measles is made, and laboratory confirmation is obtained through measles-specific IgM serology. The child is managed with supportive care, including hydration, fever control, and vitamin A supplementation. His parents are counseled on the importance of vaccination to prevent future infections. Over the following week, his symptoms gradually resolve, and the rash fades, leaving temporary skin discoloration.

Questions
1. What is the most likely diagnosis in this child?

a) Scarlet fever

b) Rubella

c) Measles

d) Chickenpox

2. Which clinical finding is most characteristic of measles

a) Strawberry tongue

b) Koplik spots

c) Vesicular rash on the trunk

d) Swollen salivary glands

3. What is the most important supportive treatment for this patient?

a) Antiviral therapy

b) Vitamin A supplementation

c) Antibiotics

d) Corticosteroids

4. How can measles be prevented?

a) Isolation of infected individuals only

b) Early antibiotic prophylaxis

c) Vaccination with the MMR vaccine

d) Avoiding crowded areas

Reveal answers

Answers

1. Answer: c) Measles

The combination of high fever, cough, conjunctivitis, Koplik spots, and a spreading maculopapular rash strongly suggests measles. Scarlet fever and rubella also cause rashes but have different clinical presentations.

2. Answer: b) Koplik spots

Koplik spots (tiny white lesions on a red base inside the mouth) are pathognomonic for measles and often appear before the rash. Their presence helps differentiate measles from other viral exanthems.

3. Answer: b) Vitamin A supplementation

Vitamin A reduces measles-related complications, especially in children. Supportive care also includes hydration, fever management, and monitoring for secondary infections.

4. Answer: c) Vaccination with the MMR vaccine

The measles, mumps, and rubella (MMR) vaccine is highly effective in preventing measles and is recommended as part of routine childhood immunization programs.