A five-year-old male with a four-day history of fever presents with a new erythematous rash. His mother says he has been coughing and sneezing for the past few days. Examination reveals conjunctivitis, grayish elevations on the buccal mucosa opposite his molar teeth, and a maculopapular rash on his trunk and extremities.
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Answer: Subacute sclerosing panencephalitis
This patient’s symptoms and examination findings are consistent with a diagnosis of measles. Subacute sclerosing panencephalitis (SSPE) — a progressive neurodegenerative disease — is an uncommon, but fatal long-term complication of the condition that can occur 7 to 10 years after the initial measles virus infection. While the pathogenesis is not fully understood, SSPE may be caused by a persistent infection of the central nervous system with a genetic variant of the measles virus. The severity of SSPE reinforces the importance of the measles vaccination for preventing measles and its associated complications.
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