Open AccessDelay in the diagnosis of measles complicated by pneumonitis and appendicitis in a returning traveller
Author(s) -
N Laundy,
Julia Greig,
Mohammad Raza,
Tamara Mitchell
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-232652
Subject(s) - medicine , measles , pneumonitis , appendicitis , rash , intensive care unit , emergency department , bronchoalveolar lavage , surgery , malaise , abdominal pain , radiology , pediatrics , lung , pathology , vaccination , psychiatry
A 40-year-old British man presented to the emergency department for the second time in 10 days following a 2-week holiday in Thailand with malaise, bilateral conjunctivitis and a morbilliform rash. He had previously seen his general practitioner and ophthalmology and was diagnosed with conjunctivitis. We confirmed measles following RNA detection on a mouth swab. Four days after admission he developed abdominal pain and a CT abdomen demonstrated acute appendicitis with large appendicoliths. A perforated appendix was identified intraoperatively. Measles RNA was detected in the resected appendix. Preoperatively he developed hypoxia with right upper lobe changes seen on a CT pulmonary angiogram. Bronchoalveolar lavage performed in theatre isolated measles RNA at high level, consistent with measles pneumonitis. He required ventilatory support in the intensive care unit and was also treated with intravenous antibiotics. He made a complete recovery.