Severe measles pneumonitis in adults: evaluation of clinical characteristics and therapy with intravenous ribavirin.

Between February and April 1991, six adults were admitted to the New York Hospital because of measles pneumonitis. The diagnosis was confirmed by serology and/or viral culture. Uncommon clinical features among patients with this diagnosis included thrombocytopenia, hepatitis, myositis, and hypocalcemia. All patients were markedly hypoxic (initial alveolar--arterial oxygen gradients while the patients were breathing room air, 40-61 mm Hg); four required support with mechanical ventilation. All patients received therapy with intravenous ribavirin (20-35 mg/[kg.d]) for 1 week. The respiratory status of five patients (one of whom was positive for human immunodeficiency virus [HIV]) who were treated early (days 2-5 of illness) promptly improved; all abnormal parameters eventually returned to baseline. Treatment of the sixth patient, who was presumed to be HIV-infected, was initiated on hospital day 22; this patient died of progressive oxygenation failure on day 38. We conclude that life-threatening measles pneumonitis in adults may be more common that previously appreciated, regardless of the patient's immune status. Therapy with intravenous ribavirin was well tolerated by our patients and was associated with reversal of respiratory compromise.