ABSTRACT
Introduction: Following an alarming surge of measles cases from declining immunization rates, it is important that clinicians recognize measles as a possible cause of otherwise unexplained symptoms, especially in patients with uncertain immunological status. Case: Over a 4-month period, a 76-year-old woman with a history of treated breast cancer experienced rapidly progressive and fluctuating focal weakness and numbness primarily affecting her lower extremities. Initially complaining of vague gastrointestinal symptoms upon returning from an extended stay in Florida, she was found to have active demyelinating lesions of her brain, cervical, and thoracic cord on MRI. This was initially thought to be new onset multiple sclerosis. CSF analysis showed critically high protein and, upon repeat analysis, positive rubeola and herpes IgM, which were elevated despite high dose steroid infusions and a steroid taper. Alternative diagnoses were ruled out, including: other infectious etiologies;endocrine/metabolic disorders;drug toxicity;malignancy;paraneoplastic disorders;transverse myelitis;multifocal cord infarction;stroke;seizure;and others. Repeat images displayed improvement of lesions and the patient was discharged to acute rehab with close neurological follow-up without steroids. Discussion: Acute disseminated encephalomyelitis is more likely in children, though cases are rare. This case of disseminated measles underscores the critical need for continued vaccination of at-risk populations, especially in those who are elderly or immunocompromised. Previous titers for immunity were not known, a potential limitation. Recent evidence demonstrates measles' ability to cause immune system "amnesia," potentially explaining this patient's concomitant herpes. As COVID-19 cases continue to present, recent evidence has linked the protective effect of the MMR vaccine against COVID-19's spread and severity. Conclusion: It is imperative that measles and other severe, preventable diseases continue to be closely monitored. Clinicians should assess benefits of proactively measuring rubeola titers in patients of all ages or in those who have previously received extensive immunosuppressive therapy.