Objective: To investigate the clinical and chest radiological features of atypical measles syndrome (AMS), and therefore to improve the recognition and diagnosis of the disease.
Methods: The clinical features, laboratory tests and chest radiological manifestations of 51 cases of outbreak AMS in one high school of Shanxi province were retrospectively analyzed.
Results: There were 31 males and 20 females, aging 18 - 33 years old. The main clinical presentations included fever (50/51), headache and dizziness (44/51), fatigue (31/51), nasal discharge (1/51), sore throat (10/51), cough (5/51), dyspnea (3/51), dacryorrhea (13/51), Koplik's spots (1/51), and skin rash (18/51) which were mostly congested maculopapules and firstly appeared on the hands, the feet and the back. Laboratory tests showed that the peripheral WBC count was in the normal range in most of the patients (n = 39), and lower than normal in 7 cases. The percentage of lymphocytes was less than 20% in 29, 20% - 40% in 20, and higher than 40% in 2 cases. The percentage of neutrophils was higher than 70% in 33 cases. Abnormal urinalysis (13/51) included positive urine protein and OB. High CRP (36/51), abnormal liver function (2/51), and abnormal renal function (1/51) were also observed. Forty-eight cases showed abnormal chest CT, manifested mostly as bilateral multiple lesions of different sizes and low density nodules and patchy areas, distributed randomly from apex to base, and from the middle zone to the pleura.
Conclusions: The clinical manifestation of AMS is atypical, characterized by the lower incidence of catarrh symptom and skin rashes with atypical appearance, but higher incidence of lung lesions. Familiarity with the atypical clinical manifestations and radiological features of AMS, epidemiological study and measles antibody detection are important for rapid and accurate diagnosis of the disease.