Measles coinfection in an unvaccinated adolescent with secondary pulmonary TB - a case report

Romania records the highest tuberculosis incidence in the European Union (44.3 per 100,000 inhabitants) and accounts for 77.8% of EU measles cases (1,447 per million inhabitants). Lack of vaccination remains the key determinant of both epidemics.

A 17-year-old unvaccinated female from a rural area presented with serologically confirmed measles during the intensive phase of antituberculous treatment for extensive secondary pulmonary tuberculosis with polyserositis. The diagnosis of tuberculosis had been established by positive AFB smear (2+ and 4+) and Xpert MTB/RIF molecular testing. Measles was confirmed by the pathognomonic clinical triad (generalised micro-maculopapular rash, Koplik's spots, conjunctival hyperaemia) and positive anti-measles IgM serology. The clinical course was marked by measles-induced immunosuppression, hepatotoxicity (ALT 156 U/L; AST 131 U/L), thrombocytopenia (platelets 122 × 10³/μL), leukopenia (WBC 3.65 × 10³/μL), and worsening of pre-existing cavitary pulmonary lesions on serial chest CT.

Measles-tuberculosis coinfection in an unvaccinated adolescent represents a complex clinical emergency with significant multisystem morbidity. MMR and BCG vaccination, active community screening, and directly observed therapy (DOT) remain the indispensable pillars of prevention.