What's your diagnosis?

A 54-year-old woman has presented with five days of fever, cough, and rhinorrhoea after returning from a missionary visit to the Philippines.

Yale University doctors report she has no clinically significant medical history and does not recall having had measles.

They say she has been fully vaccinated, including against the measles vaccine, although records of dosing and strain are not available.

Writing in the New England Journal of Medicine, they report their examination has revealed “an exanthem involving the head, neck, and shoulders with cephalocaudal spread, small white papules on buccal mucosa bilaterally, conjunctivitis with serous discharge and cervical lymphadenopathy”.

Laboratory evaluation shows elevated aminotransferase levels, leukopenia, and thrombocytopenia.

Which is the most likely diagnosis?

  • Polymorphous light eruption
  • Dengue fever
  • Measles
  • Stevens-Johnson syndrome
  • Acute cutaneous lupus erythematosus

If you answered “measles”, you’re right.

This case highlights classic clinical features of measles, say the authors.

You can read the full case report here.

The New England Journal of Medicine © 2016
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