Snapshot A young couple brings their newly adopted 2-year-old son to the pediatrician because he has a temperture of 104 degrees F and a rash. The report that the rash began at his head and face and spread downward to the extremities. The mother reports that prior to developing the rash the child had cough, inflammed lips, and red eyes. Introduction Childhood infection caused by the measles virus (paramyxovirus) Displays a 10-12 day incubation period followed by a prodrome and classic rash Epidemiology Uncommon in developed countries where vaccines are used 1:2000 cases progress to encephalitis Presentation Symptoms prodrome fever usually high (>104o F) malaise followed by 3C's cough coryza (erythematous mucous membranes, nasolabial usually) conjunctivitis rash erythematous, maculopapular rash develops with fever starts on face and spreads downward, fading from top to bottom with progression typically excludes palms and soles Physical exam Koplik's spots diagnostic small, irregular, red spots with central white/gray specks on the buccal mucosal resolve before onset of rash Evaluation Diagnosis is based primarily on clinical observation, patient history, and physical exam PCR may confirm diagnosis Serology titers used to demonstrate immunity post-vaccination Differential Other viral exanthems including erythema infectiosum, rubella, roseola infantum, varicella, coxsackie viruses, drug exposure that causes morbiliform rash Treatment Medical management immunoglobulin administration indicated for use in exposed individuals to alter clinical disease vitamin A (200,000 U daily for 2 days) reduces mortality in children < 2 y symptom management tylenol for fever moisturizing lotion for rash maintain hydration Prognosis, Prevention, and Complications Prognosis most dangerous in infants and the elderly Prevention vaccination Complications otitis media is the most common complications others may include giant cell pneumonia and larygnotracheitis most severe complication is subacute sclerosing panencephalitis in 1:2000 cases