A 3-year-old boy develops high fever (40°C), cough, coryza, and conjunctivitis for 3 days. His vaccination history is incomplete. Small bluish-white spots on a red background are noted on the buccal mucosa. The following day, a maculopapular rash appears behind the ears and spreads centrifugally to the face, trunk, and limbs. He develops increasing respiratory distress. Chest X-ray shows bilateral infiltrates. What is the most likely serious complication?

• A Subacute sclerosing panencephalitis (SSPE)
• B Post-infectious encephalomyelitis
• C Bacterial superinfection with Streptococcus pneumoniae
• D Giant cell pneumonia (Hecht's pneumonia) ✓

Explanation

This child has measles (Koplik spots, cephalocaudal rash, 3 Cs: cough, coryza, conjunctivitis). The most immediately serious complication given respiratory distress at the time of the rash is Hecht's giant cell pneumonia (measles pneumonia), caused by direct viral replication in the lungs; it is particularly severe in immunocompromised children (measles inclusion body pneumonia). SSPE (Dawson's encephalitis) is a late complication occurring 7–10 years after infection. Post-infectious encephalomyelitis is an immune-mediated complication occurring 1–3 weeks after the rash, not during the acute rash phase with respiratory distress. Bacterial superinfection is common but this clinical scenario with bilateral infiltrates during active measles points to viral pneumonia.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.