A rare complication of measles infection presented with subacute sclerosing panencephalitis: Report of two cases in India

Abstract

Rationale: Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder caused by persistent measles virus infection. SSPE predominantly affects children and adolescents. The symptoms usually develop 6-15 years after measles infection and ultimately leading to death in many cases.

Patient concerns: Patient 1 presented with cognitive decline and myoclonus and the Patient 2 presented with diminution of vision with myoclonic jerks.

Diagnosis: Based on the clinical features with a characteristic electroencephalogram pattern and the presence of a high titer of anti-measles IgG in serum and cerebrospinal fluid, these patients were diagnosed as SSPE.

Interventions: Antiepileptics were started for controlling myoclonus along with supportive treatment.

Outcomes: Both patients were discharged on antiepileptics and supportive care.

Lessons: Whenever there are unusual clinical manifestations with unknown vaccination status, SSPE can be suspected and the cerebrospinal fluid should be examined for anti-measles antibodies. Our case study also highlights the importance of universal coverage of measles vaccination. To reduce the incidence of measles and associated deaths, it is important to maintain a high level of immunization coverage for the measles vaccine and to strengthen all the integral components of the national immunization program.

Keywords

Subacute sclerosing panencephalitis / Measles / Myoclonus / Electroencephalogram / Cerebrospinal fluid

References

[1] Fisher DL, Defres S, Solomon T. Measles-induced encephalitis. QJM 2015; 108: 177-182.

[2] Garg RK, Kumar N, Rizvi I, Jain A, Jaipuriar RS, Sharma PK, et al. Case report: Subacute sclerosing panencephalitis presenting as acute encephalitis. Am J Trop Med Hyg 2019; 101(1): 260-262. doi: 10.4269/ajtmh.19-0215.

[3] Jafri SK, Kumar R, Ibrahim SH. Subacute sclerosing panencephalitis-current perspectives. Pediatric Health Med Ther 2018; 9: 67-71. doi: 10.2147/PHMT.S126293.

[4] Krumova S, Andonova I, Stefanova R, Nenkova G, Genova-Kalou P. Measles virus and subacute sclerosing panencephalitis. Clin Lab 2022; 68(9). doi: 10.7754/Clin.Lab.2021.211147.

[5] Rocke Z, Belyayeva M. Subacute sclerosing panencephalitis. Treasure Island (FL): StatPearls Publishing; 2023.

[6] Gutierrez J, Issacson RS, Koppel BS. Subacute sclerosing panencephalitis: An update. Dev Med Child Neurol 2010; 52(10): 901-907. doi: 10.1111/j.1469-8749.2010.03717.x.

[7] Ichiyama T. Clinical course and findings in and differential diagnosis of subacute sclerosing panencephalitis. Nihon Rinsho 2007; 65(8): 1481-1482.

[8] Kannan L, Garg SK, Arya R, Sankar MJ, Anand V. Treatments for subacute sclerosing panencephalitis. Cochrane Database System Rev 2013; doi: 10.1002/14651858.CD010867.

[9] Sulaiman SA, Vora NM, Chhabra K, Bashir MA, Awan ZJ. Pediatric subacute sclerosing panencephalitis: A narrative review on measles and the future of vaccination. Child Neurol 2024; doi: 10.1177/08830738241238860.

[10] Shrivastava SR, Shrivastava PS, Ramasamy J. Measles in India: Challenges & recent developments. Infect Ecol Epidemiol 2015; 5: 27784. doi: 10.3402/iee.v5.27784.