Severe Post-Measles ARDS with Multisystem Complications in an Unvaccinated Child in a Resource-Limited Setting: A...

Measles remains a major cause of preventable severe pediatric illness in low-resource settings where vaccination coverage is suboptimal and outbreaks continue to occur. Severe complications, particularly pneumonia, may be fatal, and in rare cases pulmonary involvement can progress to acute respiratory distress syndrome requiring intensive care support.

A 2-year-old unvaccinated girl from a rural area presented with 1 week of fever and progressive respiratory distress after a recent clinically suspected measles illness characterized by fever and generalized rash during community measles circulation. She arrived critically ill with severe hypoxemia, tachypnea, hypotension, and depressed consciousness, requiring urgent intubation and pediatric intensive care. Chest imaging showed diffuse bilateral infiltrates consistent with severe pneumonia. In the setting of acute hypoxemic respiratory failure requiring invasive mechanical ventilation, together with the absence of a primary cardiogenic explanation on echocardiography, the clinical findings supported pediatric acute respiratory distress syndrome. Echocardiography showed mild pericardial effusion without hemodynamic compromise. She was managed with mechanical ventilation, broad-spectrum antimicrobials, age-appropriate vitamin A, sedation/analgesia, electrolyte correction, blood transfusion for severe anemia, diuresis for fluid overload, and enteral nutrition. She was extubated after 14 days, transferred out of intensive care on day 18, and discharged in good clinical condition after 27 days of hospitalization.

This case highlights the life-threatening course of post-measles acute respiratory distress syndrome in an unvaccinated child and shows that favorable outcomes are possible with early recognition, timely intensive supportive care, and close monitoring for multisystem complications. It also underscores the importance of strengthening routine immunization coverage and referral pathways in resource-limited settings.