Measles-induced Acute Disseminated Encephalomyelitis in a No
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Measles is highly contagious but can be avoided with adequate vaccination. The disease may cause severe respiratory and neurological complications. Approximately 1/1,000 patients develop acute disseminated encephalomyelitis a few days after the appearance of a cutaneous rash. Measles elimination in the European Union is an urgent public health goal, yet despite the efforts of member states, there are vaccination gaps and outbreaks do occur.

Between 1 July 2015 and 30 June 2016, some 1,818 measles cases were reported in the European Economic Area (EU/EEA), 309 of which occurred in Germany, a country where vaccination is not mandatory. Mandatory vaccination has always been controversial and gives rise to opposition and debate. Inflammation and demyelinating lesions of the central nervous system can be induced by measles vaccination or infection. The diagnosis must be confirmed by serology or polymerase chain reaction (PCR). Morbidity and mortality can be high even in patients who have shown clinical improvement following administration of intravenous corticosteroids or immunoglobulins.

This article reports a case of measles-induced acute disseminated encephalomyelitis (ADEM) in a 40-year-old immunocompetent adult. The patient presented a week after the development of respiratory symptoms and a cutaneous rash, and was admitted to hospital for altered mental status. Blood tests showed hyperleukocytosis, thrombopenia and cytolysis. A lumbar puncture was consistent with acute meningitis and the patient was initially treated with antiviral and wide broad-spectrum antibiotics. Serology and PCR for measles came back positive.

Measles-induced ADEM is an uncommon but severe complication of measles infection. Corticosteroid therapy must be considered even in the absence of current established treatment recommendations. Preventive treatment such as vaccination or immunoglobulins should be considered in individuals previously in contact with a confirmed case.

Source: https://www.ejcrim.com/index.php/EJCRIM/article/view/1332/2031
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