A 12-year-old boy is brought by his mother to the physician’s office. His mother reports that recently he has been acting strangely, has developed an unsteady gait, and has had two seizures. He was an excellent student until recently and occasionally he lashes out in aggressive fits of anger which is new for him. His family were refugees and recently moved to the United States from Afghanistan. His mother cannot remember which vaccinations he received as a child. She states that he has not been ill recently but remembers that as a young child he was ill with a red rash covering his face and body. Vital signs are normal. Physical examination shows a lethargic boy with an ataxic gait and 3+ reflexes in the lower extremities bilaterally.
D) Subacute sclerosing panencephalitis
This patient most likely has subacute sclerosing panencephalitis which us caused by the measles (rubeola) virus. Recall that the measles virus causes cough, Koplik spots, conjunctivitis, and coryza in susceptible patients. Specifically, patients who are unvaccinated are susceptible. Patients typically develop a maculopapular rash that starts on the head and spreads downward a few days later.
Subacute sclerosing panencephalitis is a chronic encephalitis that occurs around 10 years after a patient is infected with measles virus. It causes demyelination of the central nervous system. Neurologic symptoms develop over time, including changes in behavior related to school and personality. Eventually patients become lethargic and develop seizures, myoclonus, dementia, and coma.
Answer choice A: Mumps virus aseptic meningitis, is incorrect. Mumps virus aseptic meningitis usually presents with low-grade fever, nuchal rigidity, and headache.
Answer choice B: Rabies, is incorrect. Rabies begins with a prodrome of low-grade fever, chills, myalgias, fatigue, anorexia, nausea, vomiting, headache, and sore throat with progression to either encephalitic or paralytic rabies.
Answer choice C: Rift Valley fever, is incorrect. Rift Valley fever is an acute, febrile illness caused by the Rift Valley fever virus which is transmitted by mosquitoes or through contact with infected animals. Rift Valley fever is found in East Africa with outbreaks also reported in West Africa.
Answer choice E: Yellow fever, is incorrect. Yellow fever occurs in tropical regions of sub-Saharan Africa and South America. Onset appears abruptly 3-6 days after the bite of an infected mosquito. The spectrum of disease varies from subclinical infection to a nonspecific febrile illness without jaundice to life-threatening disease with fever, jaundice, hemorrhage, and renal failure.
Key Learning Point
Subacute slcerosing panencephalitis is a chronic encephalitis that generally occurs 10 years after initial infection with measles virus. It causes behavior changes, lethargy, seizures, dementia, coma, and eventually may lead to death.
