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Abstract:
Two patients who were admitted in the prodromal stage of measles with right lower quadrant pain are described. One patient underwent appendectomy. Histologic examination of the appendix showed the characteristic Warthin-Finkeldey giant cells in the subepithelial layer and allowed the pathologist to predict a measles rash before it appeared. The second patient's pain resolved spontaneously and the measles rash appeared just prior to discharge from the hospital. A discussion of the association between measles and appendicitis is presented. It is concluded that although the association between measles and right lower quadrant abdominal pain is interesting, it must not dissuade the surgeon from performing an appendectomy if the patient's signs and symptoms suggest appendicitis.
Insights
Measles can cause right lower quadrant pain, mimicking appendicitis. Histologic Warthin-Finkeldey giant cells in the appendix can predict measles, but appendectomy is crucial if appendicitis is suspected.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Measles (rubeola) is a highly contagious viral illness.
- Right lower quadrant pain can present with various differential diagnoses, including appendicitis.
Observation:
- Two pediatric patients presented with prodromal measles and right lower quadrant pain.
- One patient underwent appendectomy, revealing Warthin-Finkeldey giant cells in the appendix.
- The second patient's pain resolved spontaneously, with a measles rash appearing later.
Findings:
- Histologic examination of the appendix identified Warthin-Finkeldey giant cells, indicative of measles.
- The presence of these cells allowed for prediction of the measles rash.
- The association between measles and appendicitis symptoms was observed.
Implications:
- The findings highlight a potential diagnostic challenge in differentiating measles prodrome from appendicitis.
- Surgeons must maintain a high index of suspicion for appendicitis despite concurrent measles symptoms.
- Early recognition and appropriate surgical intervention remain paramount for suspected appendicitis.