VIÊM NÃO CẤP DO SỞI KHỞI PHÁT TRƯỚC PHÁT BAN Ở NGƯỜI LỚN HẬU COVID-19: MỘT THÁCH THỨC CHẨN ĐOÁN

Abstract

Background: Measles in adults is relatively uncommon but carries a higher risk of severe progression and complications compared to pediatric cases. Recently, numerous adult measles cases in Vietnam have presented with atypical manifestations, posing challenges for early diagnosis and timely management. This report describes a case of adult measles characterized by multiple atypical features. Case Presentation: A 45-year-old male with no significant past medical history, who had a mild COVID-19 infection in 2022, presented with fatigue and low-grade fever, followed rapidly by altered consciousness, generalized seizures, and coma within two days. Initial clinical examination revealed no rash, and measles-specific IgM serology was negative, complicating the diagnosis. However, erythematous rash and Koplik spots emerged on the third day, and RT-PCR of nasopharyngeal swab confirmed measles virus infection. Cerebrospinal fluid (CSF) analysis was consistent with viral encephalitis. The patient received intensive treatment with high-dose corticosteroids, intravenous immunoglobulin (IVIG), vitamin A, and comprehensive supportive care. Clinical condition improved rapidly, and full recovery without neurological sequelae was achieved after eight days of hospitalization. Conclusion: This case of early-onset measles encephalitis in an adult illustrates the potential for atypical clinical progression, which may hinder diagnosis if not promptly considered and tested. The unusual presentation could be related to post-COVID-19 immune dysregulation and an immunity gap in the adult population. Serological surveys are warranted to assess herd immunity status, providing a foundation for the development of more appropriate and effective supplemental immunization programs in the near future.