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We present a case of a 43-year-old male with a post-acute measles encephalitis presenting with high fever, mental change, polyradiculopathy, cerebellitis, without typical skin rashes. Standardized clinical exams were performed and blood, CSF samples were collected for lymphocyte and measles and auto-antibody analyses.

The patient presented with a change in in mental status, confusion and fever, but no prominent signs of measles infection such as a skin lesion, Koplik’s spot and coryza. Patient’s serum IgM and IgG Ab were positive for measles infection while brain imaging and CSF analysis were also negative for any sign of CNS infection. Nerve conduction velocity test revealed polyradiculopathy. The patient was treated with 5 days of steroid pulse therapy and all the symptoms resolved dramatically during the following days.

The fact that our patient had no sign of measles antibodies in the cerebrospinal fluid (CSF), and that all symptoms resolved dramatically after a steroid pulse injection prompted us to make the diagnosis of acute post-measles encephalopathy.  This case emphasizes the importance of measles screening in patient presenting with mental change as measles infection may present itself without prominent signs such as skin lesion or CSF pleocytosis.