A 5-year-old child presents with fever, maculopapular rash that started on the face and descended to the trunk and extremities over 3 days, Koplik spots on buccal mucosa, and bilateral conjunctivitis. On day 5 of illness, he develops worsening cough, high fever, and new lung infiltrates. What is the MOST likely pulmonary complication?

• A Secondary bacterial pneumonia (Streptococcus pneumoniae) ✓
• B Primary measles giant cell pneumonitis (Hecht's pneumonia)
• C Measles croup (laryngotracheobronchitis)
• D Pulmonary tuberculosis reactivation

Explanation

Secondary bacterial pneumonia is the MOST COMMON cause of measles-related mortality and occurs due to immune suppression caused by the measles virus. Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae are the most common pathogens. Hecht's pneumonia (giant cell pneumonitis) occurs in immunocompromised patients, often without the typical rash, and can be fatal. Croup may occur but is an upper airway complication, not new lung infiltrates. TB reactivation is possible but not the most likely cause acutely.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.