Measles inclusion-body encephalitis caused by the vaccine strain of measles virus.
We report a case of measles inclusion-body encephalitis (MIBE) occurring in an apparently healthy 21-month-old boy 8.5 months after measles-mumps-rubella vaccination. He had no prior evidence of immune deficiency and no history of measles exposure or clinical disease. During hospitalization, a primary immunodeficiency characterized by a profoundly depressed CD8 cell count and dysgammaglobulinemia was demonstrated. A brain biopsy revealed histopathologic features consistent with MIBE, and measles antigens were detected by immunohistochemical staining. Electron microscopy revealed inclusions characteristic of paramyxovirus nucleocapsids within neurons, oligodendroglia, and astrocytes. The presence of measles virus in the brain tissue was confirmed by reverse transcription polymerase chain reaction. The nucleotide sequence in the nucleoprotein and fusion gene regions was identical to that of the Moraten and Schwarz vaccine strains; the fusion gene differed from known genotype A wild-type viruses.
Bitnun
A
A
Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Shannon
P
P
Durward
A
A
Rota
P A
PA
Bellini
W J
WJ
Graham
C
C
Wang
E
E
Ford-Jones
E L
EL
Cox
P
P
Becker
L
L
Fearon
M
M
Petric
M
M
Tellier
R
R
D018792:Encephalitis, Viral / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007181:Inclusion Bodies, Viral; D007223:Infant; D008297:Male; D008457:Measles / Q000150:complications*; D008458:Measles Vaccine / Q000009:adverse effects*; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine / Q000009:adverse effects*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012411:Rubella Vaccine / Q000009:adverse effects*; D017778:Vaccines, Combined / Q000009:adverse effects
D008458:Measles Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D009108:Mumps Vaccine; D012411:Rubella Vaccine; D017778:Vaccines, Combined