HISTORY AND CLINICAL FINDINGS: A 35-year-old man, for 6 years known to have non-Hodgkin lymphoma (NHL) was admitted because of deteriorating general condition, drowsiness and 11 days of flu-like symptoms. A generalized rash had been noted 5 days after onset of symptoms. His 2-year-old son had fallen ill with measles a few days earlier. The patient had reportedly had measles as a child. On admission a generalized rash was found, he had a fever of 40.5 degrees C, tachypnoea, conjunctivitis and possible meningismus. INVESTIGATIONS: Lactate dehydrogenase activity was raised to 458 U/ml, and C-reactive protein to 240 mg/ml. Cerebrospinal fluid contained 8/3 cells and protein of 269 mg/l. The chest radiogram revealed opacification in the left upper lobe. Computed tomography of the skull demonstrated a pansinusitis. DIAGNOSIS, TREATMENT AND COURSE: As measles encephalitis seemed unlikely he was treated for the measles superinfection of bacterial pneumonitis (measles RNA in the bronchoalveolar lavage) and the sinusitis with broad-spectrum antibiotics. After initial improvement artificial ventilation had to be be gun on day 3 because of an acute respiratory distress syndrome, diagnosed both clinically and radiologically. Despite additional antiviral and intensive medical treatment he died on day 11. CONCLUSION: Patients with impaired immunocompetence due to NHL may lose their immunological "memory" for a previous measles infection. Prevention of exposure may therefore be necessary, in addition to early hyperimmunoglobulin administration.
HISTORY AND CLINICAL FINDINGS: A 35-year-old man, for 6 years known to have non-Hodgkin lymphoma (NHL) was admitted because of deteriorating general condition, drowsiness and 11 days of flu-like symptoms. A generalized rash had been noted 5 days after onset of symptoms. His 2-year-old son had fallen ill with measles a few days earlier. The patient had reportedly had measles as a child. On admission a generalized rash was found, he had a fever of 40.5 degrees C, tachypnoea, conjunctivitis and possible meningismus. INVESTIGATIONS: Lactate dehydrogenase activity was raised to 458 U/ml, and C-reactive protein to 240 mg/ml. Cerebrospinal fluid contained 8/3 cells and protein of 269 mg/l. The chest radiogram revealed opacification in the left upper lobe. Computed tomography of the skull demonstrated a pansinusitis. DIAGNOSIS, TREATMENT AND COURSE: As measles encephalitis seemed unlikely he was treated for the measles superinfection of bacterial pneumonitis (measles RNA in the bronchoalveolar lavage) and the sinusitis with broad-spectrum antibiotics. After initial improvement artificial ventilation had to be be gun on day 3 because of an acute respiratory distress syndrome, diagnosed both clinically and radiologically. Despite additional antiviral and intensive medical treatment he died on day 11. CONCLUSION:Patients with impaired immunocompetence due to NHL may lose their immunological "memory" for a previous measles infection. Prevention of exposure may therefore be necessary, in addition to early hyperimmunoglobulin administration.