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Case report
Delay in the diagnosis of measles complicated by pneumonitis and appendicitis in a returning traveller
  1. Nicholas C Laundy1,
  2. Julia M Greig1,
  3. Mohammad Raza2 and
  4. Tamara Mitchell1
  1. 1 Infectious Diseases, Sheffield Teaching Hospitals, Sheffield, UK
  2. 2 Virology, Sheffield Teaching Hospitals, The University of Sheffield, Sheffield, UK
  1. Correspondence to Dr Nicholas C Laundy; nick.laundy{at}


A 40-year-old British man presented to the emergency department for the second time in 10 days following a 2-week holiday in Thailand with malaise, bilateral conjunctivitis and a morbilliform rash. He had previously seen his general practitioner and ophthalmology and was diagnosed with conjunctivitis. We confirmed measles following RNA detection on a mouth swab. Four days after admission he developed abdominal pain and a CT abdomen demonstrated acute appendicitis with large appendicoliths. A perforated appendix was identified intraoperatively. Measles RNA was detected in the resected appendix. Preoperatively he developed hypoxia with right upper lobe changes seen on a CT pulmonary angiogram. Bronchoalveolar lavage performed in theatre isolated measles RNA at high level, consistent with measles pneumonitis. He required ventilatory support in the intensive care unit and was also treated with intravenous antibiotics. He made a complete recovery.

  • vaccination/immunisation
  • TB and other respiratory infections
  • global health
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  • Contributors NCL is an infectious diseases registrar and is listed as the 1st author. He prepared this case report and was heavily involved in the patient’s management and treatment during his inpatient stay in the infectious diseases ward and intensive care. TM is an infectious diseases registrar who also managed this patient as an inpatient and contributed to the writing of this case report. MR is a virologist who was responsible for coordinating infection control efforts and contact tracing through liaison with Public Health England. He assisted in the writing of this report. JMG is an infectious diseases physician, was the named consultant and oversaw the care of this patient both as an inpatient and outpatient. She contributed to the writing and editing of this report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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