Abstract Details

Title Neurological Complications of Measles: A Case of Encephalitis in an Immunocompromised Young Adult with Seizures and Multifocal T2 Hyperintensities

Topic Autoimmune Neurology

Presentation(s) P9 - Poster Session 9 (5:00 PM-6:00 PM)

Poster/Presentation
Number 2-003

Objective To describe a rare case of measles-associated central nervous system (CNS) disease and review the major neurological complications of measles. In doing so, we aim to aid clinicians in recognition and evaluation.

Background N/A

Design/Methods N/A

Results A 21-year-old unvaccinated male with a history of hypoplastic left heart syndrome status-post Fontan surgery, AV-block status-post pacemaker, protein-losing enteropathy with resultant hypogammaglobulinemia, and T cell lymphopenia presented to the hospital with new-onset seizures. Symptoms began with involuntary right leg jerking, which progressed over a span of two weeks to involve frequent full body jerking and facial twitching with preserved awareness. He also experienced one generalized tonic-clonic seizure. EEG revealed myoclonic seizures on left hemisphere corresponding with his facial twitching, as well as subclinical seizures. Anti-seizure medication escalated with levetiracetam, clobazam, oxcarbazepine, and valproate for better control. He was severely dysarthric, increasingly somnolent, and with severe hemiparesis. Imaging demonstrated multifocal areas of non-enhancing T2 hyperintensity with associated edema, involving bilateral cortical and basal ganglia regions. Serology revealed markedly elevated measles IgG titers (>300 U/mL), which had also been positive four months prior, suggesting a recent infection. CSF studies showed a mixed pleocytosis (45 WBCs with 32% lymphocytes and 66% mono/macrophages) and positive measles IgG. Of note, he also had low-titer R. typhi IgM (1:64) and an incidental splenic infarct. Given concern for measles-related encephalitis, he received 500mg/kg of intravenous immunoglobulin treatment for five days with improved neurological symptoms and seizure control.

Conclusions Measles is a highly contagious viral illness that can result in severe CNS complications, including acute postinfectious measles encephalitis (APME), measles inclusion body encephalitis (MIBE), and subacute sclerosing panencephalitis (SSPE). Although neurological sequelae are rare, they are associated with high morbidity and mortality, particularly in immunocompromised individuals and children. Recognition of CNS manifestations is critical, given the resurgence of measles globally and its devastating outcomes.

Authors/Disclosures
Avni Kapadia, MD (Baylor College of Medicine) PRESENTER	Dr. Kapadia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Annexon. The institution of Dr. Kapadia has received personal compensation in the range of $0-$499 for serving as a Consultant for Re Cognition. Dr. Kapadia has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Robbins Travis.
Angela P. Salemi, MD	Dr. Salemi has nothing to disclose.
Hemali Patel, DO (Baylor College of Medicine)	Dr. Patel has nothing to disclose.

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