Classic morbilliform exanthem of measles in an unvaccinated adult: rare clinical image

A 26-year-old man visited the emergency department of the dermatology department with a 5-day history of fever, nausea and vomiting and a 2-day history of a pruritic rash. The rash started at the back of the ears and spread to the rest of the body and the face in less than 24 hours. The patient is an immigrant from a Middle Eastern nation who denied any immunisation against measles, mumps, and rubella (MMR). He had a diffuse maculopapular exanthem on the face and trunk and erosive lesions on the buccal mucosa, a typical manifestation of measles virus infection, known as Koplik spots. Serology revealed positive anti-measles Immunoglobulin M (IgM) and Immunoglobulin G (IgG) antibodies, and Reverse Transcription Polymerase Chain (RT-PCR) detected viral ribonucleic acid (RNA), which proved primary measles infection. Antipyretics were used to provide supportive care to the patient. Public health authorities were also alerted, and with contact tracing, they identified five other cases without a major outbreak. The patient was cured within 2 weeks. The final diagnosis was measles (rubeola) infection. The differential diagnosis involved Rubella, Scarlet fever, Dengue fever, roseola, and drug-induced exanthema.