Post-vaccination measles infection in an immunosuppressed patient. A diagnostic and clinical challenge

Abstract

Introduction. Measles is a viral disease characterized by fever and rash. In recent years, it has become a public health problem, attributed to low vaccination coverage and late diagnosis. The measles vaccine is 95% effective. In immunosuppressed patients, there is an increased, although rare, risk of developing a post-vaccination infection. Clinical case. We present the case of a 19-month-old male patient with chronic malnutrition, hospitalized with respiratory infection and watery diarrhea. He had recently been vaccinated with MMR vaccine 19 days earlier and had a history of four previous hospitalizations for respiratory infections. He was diagnosed with human immunodeficiency virus (HIV) infection and was started on antiretroviral therapy. Fifteen days after starting ART, the patient resumed experiencing febrile episodes associated with a generalized erythematous rash. Samples were taken for surveillance of exanthematous fever, with a positive result for measles. The vaccine genotype could not be isolated. There were no contacts with symptoms or positive tests. Conclusion. In immunosuppressed individuals, live virus vaccines are contraindicated based on the level of immunosuppression, so the risk-benefit ratio should be assessed. Continued surveillance for exanthematous fever is recommended as an effective and timely measure to detect probable measles cases, as this disease has currently been eliminated in Panama.