A 3-year-old child from Bihar presents with rash on day 4 of fever. Examination shows Koplik's spots and a maculopapular rash starting from the face and spreading downward, sparing the palms and soles. On day 7, the child develops altered consciousness and focal seizures. CSF shows lymphocytic pleocytosis with elevated protein. The MOST likely CNS complication is:

• A Subacute sclerosing panencephalitis (SSPE)
• B Measles inclusion body encephalitis (MIBE)
• C Measles encephalitis (direct viral encephalitis)
• D Acute post-measles disseminated encephalomyelitis (ADEM) ✓

Explanation

Acute post-infectious ADEM occurs typically 1–3 weeks after the rash and represents immune-mediated demyelination triggered by molecular mimicry, not direct viral invasion. CSF shows lymphocytic pleocytosis with elevated protein, MRI reveals multifocal white matter lesions. Direct measles encephalitis (during acute illness) is very rare and occurs early in infection. SSPE manifests 5–10 years after measles infection. MIBE occurs in immunocompromised patients months after exposure.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.