Letter: Adult measles with a butterfly rash-like appearance

Butterfly rash is characterized by symmetrical erythema and erythematous papules and plaques grouped on the bilateral cheeks and nose, commonly found in lupus erythematosus. Measles is a highly contagious viral disease, characterized by high fever, cough, coryza, conjunctivitis, and Koplik spots, which precede generalized maculo-papular rashes. We report an adult case of measles, accompanied by butterfly rash. A 20-year-old woman came to our hospital with a butterfly rash-like eruption on the face, high fever, and arthralgia. The eruption had appeared on the nose and both cheeks three days before admission. The oral mucosa was not involved. On the basis of the three criteria for a diagnosis of lupus eruthematosus, we first made a tentative diagnosis of lupus eruthematosus and performed blood tests. However, anti-DNA antibodies, scl-70, anti-Ro and La, anti-Sm and rheumatoid factor were all negative. Two days after admission, a Koplik macule appeared along with multiple erythematous macules and papules that were scattered through the trunk. Laboratory tests were positive for anti-measles immunoglobulin M and G. Therefore, we reached a diagnosis of measles. Within a week, all of the clinical symptoms disappeared. Physicians should be aware that, in rare cases, measles may present with a butterfly-like rash.