Measles retinopathy during immunosuppression

A 14-year-old boy had an acute attack of measles while on cytotoxic chemotherapy for a testicular neoplasm. Two months later a fatal measles encephalopathy developed, verified by histological, ultrastructural, and immunofluorescent studies. Ophthalmoscopy showed progression of flat depigmented areas of the retina as well as prominent lesions mimicking central serous retinopathy or retinitis. Histopathological studies showed focal retinal necroses with invasion of pigment-laden macrophages into the retina. There were no inflammatory cell infiltrations in the choroid. The presence of structures with the morphological and antigenic properties of measles virus in the affected areas of the retina was shown by electron microsocpy and indirect immunofluorescence. With the increase of immunosuppressive therapy for various purposes the incidence of opportunistic measles virus infections is likely to rise. In the clinical management of such complications ophthalmological examination may prove very helpful.