title: The Conundrum in the Diagnosis and Management of Atypical Fulminant Measles in a Leukemia Survivor on Maintenance Chemotherapy.
abstract: We report the diagnostic and therapeutic challenges in an unusually fulminant presentation of measles, presenting as severe necrotizing bronchiolitis with secondary hemophagocytic lymphohistiocytosis (HLH) in the absence of classical clinical features in an immunocompromised host on maintenance chemotherapy. Our patient had presented with features of a viral pneumonitis without the classical exanthem, in combination with HLH. Although rhinovirus-induced HLH was highly unusual, the positive rhinovirus swab result had distracted us from the eventual diagnosis. This calls for greater impetus to increase awareness and public education to improve vaccination rates and herd immunity to curb outbreaks and protect the immunocompromised patients.
authors.affiliation: *Khoo Teck Puat-National University Children's Medical Institute‡Department of Medicine, National University Health SystemDepartments of †Paediatrics§Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: James Guoxian
authors.initials: JG
authors.lastname: Huang
authors.forename: Allen Eng Juh
authors.initials: AE
authors.lastname: Yeoh
authors.forename: Paul Anantharajah
authors.initials: PA
authors.lastname: Tambyah
authors.forename: Mas Isa
authors.initials: MI
authors.lastname: Suhaila
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018549:Cryptogenic Organizing Pneumonia / Q000175:diagnosis; D003951:Diagnostic Errors; D015199:Extracorporeal Membrane Oxygenation; D017809:Fatal Outcome; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000209:etiology; D060046:Maintenance Chemotherapy; D008297:Male; D008457:Measles / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015122:Mercaptopurine / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D009102:Multiple Organ Failure / Q000209:etiology; D010198:Pancytopenia / Q000209:etiology; D010850:Picornaviridae Infections / Q000150:complications / Q000175:diagnosis / Q000821:virology; D010951:Plasma Exchange; D011024:Pneumonia, Viral / Q000175:diagnosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy*; D012229:Rhinovirus / Q000302:isolation & purification; D018805:Sepsis / Q000209:etiology; D017741:Survivors
chemical_list: D000305:Adrenal Cortex Hormones; D000890:Anti-Infective Agents; D015122:Mercaptopurine; D008727:Methotrexate