Neurological complications of measles: a case of measles meningitis

Background. Measles is a pressing problem in modern medicine. At present, there is an epidemic problem with measles. The main reason for the current situation is considered to be a decrease in the coverage of the population with planned immunization. It is known that the acute period of measles is accompanied by severe catarrhal syndrome, intoxication and exanthema. In addition, the disease often occurs with various complications. Complications associated with damage to the central nervous system are usually considered separately, in particular: measles meningitis, encephalitis, acute disseminated encephalomyelitis (ADEM), subacute sclerosing panencephalitis (SSPE). Lesions of the nervous system in measles can occur in the acute period (meningitis, encephalitis), which indicates a direct connection with the action of the measles virus and the inflammatory reactions associated with it. Delayed damage to the nervous system (ADEM, PSPE) is also possible, pathogenetically based on immune-pathological reactions and largely realized in the presence of a genetic predisposition in a particular individual. In the second case, the measles virus can be rationally considered as a significant trigger for the manifestation of these neurological manifestations. The presence of damage to the central nervous system in measles, both in the acute period and in delayed implementations, is an alarming moment that requires special detailed monitoring of the patient.

Results. We present a clinical observation of the development and successful treatment of measles meningitis in a 12-year-old patient. The patient was not vaccinated against measles, due to the refusal of legal representatives for personal reasons. The course of measles in the patient was classical – pronounced intoxication syndrome, Stimson's catarrhal triad were noted. On the third day of the febrile period, the patient noted the appearance of a typical exanthema of a maculopapular nature with stages from top to bottom. Manifestations of typical enanthem in the form of Belsky – Filatov – Koplik spots were also recorded. The patient was hospitalized on the 6th day from the onset of the disease. Verification of the diagnosis was carried out by detecting early serological markers (IgM) to the measles virus. By the 9th day, against the background of symptomatic treatment, clinical stabilization of the condition was noted – persistent normalization of body temperature, regression of catarrhal syndrome. On the 11th day, negative dynamics were noted, manifested by the resumption of fever, the development of cephalgia, meningeal syndrome. After neuroimaging, a lumbar puncture was performed. Cytosis – 165 cells, lymphocytic (78% – lymphocytes; 22% – neutrophils). The course of measles meningitis is documented. For anti-inflammatory purposes, the patient was prescribed systemic glucocorticosteroids (in a standard dosage of 2 mg/kg of prednisolone) for a short course. Against the background of the complex pathogenetic therapy, by the 13th day it was possible to achieve stable normalization of body temperature, regression of neurological symptoms. On the 23rd day, the patient was punctured again, the cerebrospinal fluid was sanitized (cytosis – 10 cells). On the 24th day from the onset of the disease, the patient was discharged in a satisfactory condition for further observation by the local pediatrician.

Conclusion. This clinical case demonstrates the relevance of the measles problem at the present stage. Practicing doctors are required to be alert to the possibility of the implementation of neurological complications of measles.

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