Title : Report on several clinical cases of measles at the pediatrics department, Tam Anh General Hospital, Hanoi
Abstract:
Background: Measles is an acute, highly contagious viral disease transmitted via the respiratory route, predominantly affecting unvaccinated children. While the clinical course is often self-limiting and characterized by high fever, upper respiratory tract inflammation, conjunctivitis, and a maculopapular rash, serious complications may occur. Common complications include pneumonia and otitis media; less frequently, myocarditis and other systemic involvements are observed. There is currently no specific antiviral treatment for measles. Management is mainly supportive, focusing on early detection and intervention of complications.
Presentation: Case 1: A 19-month-old girl patient was admitted on day 2 of illness presenting with fever, cough, bilateral conjunctivitis, and suspected Koplik spots, but no rash at the time of admission. The child had no prior measles vaccination. Measles was confirmed on 3rd day by a positive polymerase chain reaction (PCR) assay. Initial evaluation revealed signs of lower respiratory tract involvement with white blood cell count: 10.27 G/L; C-reactive protein (CRP): 1.01 mg/dL. The patient was diagnosed with measles complicated by pneumonia and otitis media, and was started on intravenous ceftriaxone. On 5th day, the patient developed respiratory distress (tachypnea, SpO? 92–93%, and persistent high-grade fever). Chest radiography revealed diffuse patchy infiltrates. The treatment regimen was escalated to include intravenous immunoglobulin (IVIG) for three consecutive days and meropenem. Clinical improvement, including normalization of respiratory parameters, was observed within 48 hours of IVIG administration. Case 2: A 7-month-old unvaccinated infant presented with high-grade fever and marked tachycardia (heart rate 200 bpm). Initial laboratory tests showed elevated cardiac biomarkers: Troponin T at 24.7 pg/mL (reference <14 pg/mL) and CK-MB at 29.6 U/L (reference <24 U/L). Electrocardiogram and transthoracic echocardiography did not reveal structural or functional cardiac abnormalities. A provisional diagnosis of viral myocarditis was made. On day 2 of hospitalization, the child developed classic signs of measles including Koplik spots and a generalized maculopapular rash. Diagnosis was confirmed by PCR testing. The patient was managed supportively; fever subsided, heart rate normalized, and cardiac enzyme levels returned to reference range by day 6 of hospitalization. Case 3: An 11-year-old girl with no prior measles vaccination and a recent history of close contact with a confirmed measles case presented with fever, abdominal pain, and palpable purpura over both lower legs. Examination revealed pharyngeal erythema without Koplik spots. Laboratory and imaging findings: White blood cell count: 4.09 G/L; C-reactive protein (CRP): 0.213 mg/dL; Alanine aminotransferase (ALT/GPT): 233 U/L. Antistreptolysin O (ASLO): 2195 IU/mL. Urinary protein/creatinine ratio: 23 mg/mmol; negative for hematuria. Abdominal ultrasound revealed several fluid-filled, hyperperistaltic intestinal loops in the left flank region, along with mesenteric lymphadenopathy. Laboratory testing and a positive measles PCR confirmed the diagnosis of measles. Based on clinical presentation and laboratory findings, the patient was diagnosed with measles-associated abdominal variant of Henoch-Schönlein purpura (HSP). Management included supportive therapy with intravenous antibiotics, vitamin A, and proton pump inhibitors. The patient demonstrated favorable clinical response within five days of treatment. Monthly follow-up at the Pediatric Department has shown no evidence of renal involvement to date.
Conclusion: Beyond common complications such as pneumonia, measles may also give rise to rarer manifestations including acute myocarditis and the potential triggering of autoimmune conditions. These cases underscore the necessity for clinicians to implement individualized treatment strategies and close monitoring. Despite the presence of atypical complications, our patients demonstrated favorable therapeutic responses and recovered without significant long-term consequences.
Keywords: measles, complication, pneumonia, viral myocarditis, Henoch-Schönlein purpura.
