Measles-vaccinated Israeli boy with subacute sclerosing panencephalitis

Area of Science:

• Neurology
• Virology
• Immunology

Background:

• Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurologic deterioration in children and adolescents, typically associated with measles virus infection.
• While vaccination significantly reduces measles incidence, rare cases of SSPE in vaccinated individuals warrant continued vigilance and research.

Observation:

• A 16-year-old boy, fully vaccinated against measles, presented with neurological symptoms including enuresis, involuntary movements, dysarthria, and ataxia.
• Diagnostic workup revealed elevated measles-specific IgG antibodies in serum and cerebrospinal fluid (CSF) with a high CSF/serum ratio, despite negative PCR for measles.
• EEG showed characteristic slow activity with high-voltage discharges, and MRI revealed diffuse white matter changes, particularly in posterior regions and around lateral ventricles.

Findings:

• The patient's clinical presentation and laboratory findings were consistent with SSPE, despite a history of measles vaccination.
• Standard treatments including valproic acid, levetiracetam, carbamazepine, and IVIG were ineffective.
• Further treatment with inosiplex and interferon-β-1a also failed to alter the disease's fatal progression, leading to coma and death within a year.

Implications:

• This case underscores that subacute sclerosing panencephalitis should be considered in the differential diagnosis of neurological disorders in young, vaccinated populations.
• It highlights the need for further investigation into the mechanisms of SSPE pathogenesis in vaccinated individuals.
• The findings emphasize the importance of ongoing surveillance and potential re-evaluation of vaccination strategies or post-vaccination immunity monitoring for rare complications.