A 3-year-old child has fever for 4 days with a maculopapular rash starting on the face and spreading downward. Koplik spots were noted at the beginning. He received only 1 dose of measles vaccine at 9 months. Regarding measles complications in this child, which is the MOST feared long-term neurological complication?

• A Acute disseminated encephalomyelitis (ADEM) — occurs within 2 weeks of rash
• B Subacute sclerosing panencephalitis (SSPE) — occurs 7–10 years after primary measles infection ✓
• C Guillain-Barré syndrome — post-infectious demyelination
• D Measles inclusion body encephalitis — occurs in immunocompromised within months

Explanation

Subacute sclerosing panencephalitis (SSPE) is the most feared neurological complication of measles, occurring 7–10 years (range 1–27 years) after acute infection. It is a slow, fatal progressive CNS disease caused by persistent mutant measles virus (defective M protein). It is characterized by intellectual deterioration, myoclonic jerks, and EEG showing periodic complexes. Measles before age 2 carries the highest risk. ADEM is an early (2-week) autoimmune complication. MIBE occurs in immunocompromised patients shortly after infection.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.