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Acute Demyelinating Encephalomyelitis Following Measles Infection Due to Vaccine Failure: A Case Report
Robert J McMickle1, Lauren Fryling1, Ross J Fleischman1
1Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California.
Introduction:
Local outbreaks of measles infection are primarily mediated by international travel of persons from endemic areas, with subsequent spread of the virus via undervaccinated populations. Recent resurgences of measles in communities where vaccination rates are non-ideal secondary to philosophical objections require the emergency physician to more routinely consider the diagnosis. In cases of measles complicated by acute encephalitis or encephalopathy, the diagnosis can be especially difficult to make due to lack of a reliable primary historian.
Case Report:
Here we present a case of altered mental status and new-onset bilateral lower extremity weakness in a fully vaccinated young woman diagnosed with measles infection caused by acute disseminated encephalomyelitis in the setting of vaccine failure.
Conclusion:
Despite a documented history of immunization, acute measles infection and its uncommon sequelae are possible. Recognizing vaccine failure and appropriately isolating patients are of paramount importance.
Insights
Measles infection can occur even in fully vaccinated individuals, leading to serious complications like acute disseminated encephalomyelitis. Early recognition and isolation are crucial for managing this vaccine-preventable disease.
Area of Science:
- Infectious Diseases
- Neurology
- Vaccinology
Background:
- Measles outbreaks are often linked to international travel and spread in under-vaccinated populations.
- Resurgent measles cases in communities with suboptimal vaccination rates necessitate increased clinical suspicion.
- Diagnosing measles complicated by encephalitis or encephalopathy is challenging without a reliable historian.
Purpose of the Study:
- To report a case of measles infection with acute disseminated encephalomyelitis in a vaccinated individual.
- To highlight the possibility of vaccine failure in measles infection.
- To emphasize the importance of recognizing uncommon measles sequelae.
Main Methods:
- Case presentation of a fully vaccinated young woman with altered mental status and lower extremity weakness.
- Diagnostic workup for measles infection and associated neurological complications.
- Review of literature on measles vaccine failure and its sequelae.
Main Results:
- The patient was diagnosed with measles infection.
- Acute disseminated encephalomyelitis was identified as a complication.
- The case demonstrated vaccine failure despite documented immunization.
Conclusions:
- Measles infection and its rare complications, such as acute disseminated encephalomyelitis, can occur despite vaccination.
- Recognizing vaccine failure is critical for timely diagnosis and management.
- Prompt patient isolation is essential to prevent further transmission.
