[Fatal course of measles infection in a patient with a low-grade malignant non-Hodgkin lymphoma].

HISTORY AND CLINICAL FINDINGS

A 35-year-old man, for 6 years known to have non-Hodgkin lymphoma (NHL) was admitted because of deteriorating general condition, drowsiness and 11 days of flu-like symptoms. A generalized rash had been noted 5 days after onset of symptoms. His 2-year-old son had fallen ill with measles a few days earlier. The patient had reportedly had measles as a child. On admission a generalized rash was found, he had a fever of 40.5 degrees C, tachypnoea, conjunctivitis and possible meningismus.

INVESTIGATIONS

Lactate dehydrogenase activity was raised to 458 U/ml, and C-reactive protein to 240 mg/ml. Cerebrospinal fluid contained 8/3 cells and protein of 269 mg/l. The chest radiogram revealed opacification in the left upper lobe. Computed tomography of the skull demonstrated a pansinusitis.

DIAGNOSIS, TREATMENT AND COURSE: As measles encephalitis seemed unlikely he was treated for the measles superinfection of bacterial pneumonitis (measles RNA in the bronchoalveolar lavage) and the sinusitis with broad-spectrum antibiotics. After initial improvement artificial ventilation had to be be gun on day 3 because of an acute respiratory distress syndrome, diagnosed both clinically and radiologically. Despite additional antiviral and intensive medical treatment he died on day 11.

CONCLUSION

Patients with impaired immunocompetence due to NHL may lose their immunological "memory" for a previous measles infection. Prevention of exposure may therefore be necessary, in addition to early hyperimmunoglobulin administration.