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Peer-reviewedCC BY-NC-ND 4.0Tropical Medicine and Health

Acute measles encephalitis in adults: a case series in Vietnam

  • Huy Quang Nguyen1,2
  • Hung Duy Cao2
  • Thanh Van Do1,2
  • Tra Thu Doan1,2
  • Hai Viet Nguyen2
  • Vuong Minh Nong3
  • Cuong Van Bui1
  • Hai Ngoc Bui1
  • Giang Huong Luong1
  • Yoshihiro Aoki4,5
  • Kensuke Takahashi4,5
  • Chris Smith5,6
2 more authors
  • Co Xuan Dao2,7
  • Giap Van Vu3,8
8 affiliations
  1. 1Institute of Tropical Medicine, Bach Mai Hospital, 78 Giai Phong Street, Dong Da, Hanoi, Vietnam
  2. 2University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
  3. 3Institute for Training and Research in Medicine and Pharmacy, Bach Mai Hospital, Hanoi, Vietnam
  4. 4Coordination Office for Emergency Medicine and International Response, Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
  5. 5School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523 Japan
  6. 6Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
  7. 7Bach Mai Hospital, Hanoi, Vietnam
  8. 8Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
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Abstract

Background: Acute measles encephalitis is a rare but severe complication of measles, particularly in adults, and carries high mortality and a substantial risk of neurological sequelae. Two mechanisms are recognized: direct viral invasion of the brain, termed primary measles encephalitis, and an immune-mediated postinfectious process, termed acute postinfectious measles encephalitis. Most descriptions come from children, and the presentation, pathogenesis, and management of adult disease remain poorly defined.

Case presentation: We describe four adults (aged 34–45 years) admitted with fever, rash, and altered mental status. Acute measles infection was confirmed by serum measles-specific IgM or measles virus RNA on real-time reverse-transcription PCR. Measles virus RNA was detected in cerebrospinal fluid in Case 1, indicating primary measles encephalitis. Case 2 was initially mistaken for varicella because of an atypical vesicular rash. Case 3 developed quadriparesis and sphincter dysfunction with electromyographic evidence of bilateral S1 radiculopathy; spinal imaging was not performed. Case 4 showed progressive thalamic and temporal lesions on magnetic resonance imaging. Cerebrospinal fluid pleocytosis ranged from 57 to 1046 cells/µL, and improved in most patients within 3 days of intravenous immunoglobulin. Two patients recovered without neurological sequelae, one survived with residual deficits, and one died from persistent cerebral injury complicated by multidrug-resistant septic shock.

Conclusions: In adults, acute measles encephalitis may reflect a biphasic process that combines direct viral neuroinvasion with immune-mediated inflammation, rather than a purely postinfectious phenomenon. Intravenous immunoglobulin was temporally associated with clinical and biochemical improvement, but its therapeutic role cannot be established from a case series and requires controlled study.

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Cite

BibTeXRIS
BibTeX
@article{nguyen2026acute,
  title = {{Acute measles encephalitis in adults: a case series in Vietnam}},
  author = {Huy Quang Nguyen and Hung Duy Cao and Thanh Van Do and Tra Thu Doan and Hai Viet Nguyen and Vuong Minh Nong and Cuong Van Bui and Hai Ngoc Bui and Giang Huong Luong and Yoshihiro Aoki and Kensuke Takahashi and Chris Smith and Co Xuan Dao and Giap Van Vu},
  journal = {Tropical Medicine and Health},
  year = {2026},
  month = oct,
  doi = {10.1186/s41182-026-01099-y},
  url = {https://doi.org/10.1186/s41182-026-01099-y},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Acute measles encephalitis in adults: a case series in Vietnam
AU  - Huy Quang Nguyen
AU  - Hung Duy Cao
AU  - Thanh Van Do
AU  - Tra Thu Doan
AU  - Hai Viet Nguyen
AU  - Vuong Minh Nong
AU  - Cuong Van Bui
AU  - Hai Ngoc Bui
AU  - Giang Huong Luong
AU  - Yoshihiro Aoki
AU  - Kensuke Takahashi
AU  - Chris Smith
AU  - Co Xuan Dao
AU  - Giap Van Vu
PY  - 2026
DA  - 2026/10/26
JO  - Tropical Medicine and Health
DO  - 10.1186/s41182-026-01099-y
UR  - https://doi.org/10.1186/s41182-026-01099-y
AB  - Background: Acute measles encephalitis is a rare but severe complication of measles, particularly in adults, and carries high mortality and a substantial risk of neurological sequelae. Two mechanisms are recognized: direct viral invasion of the brain, termed primary measles encephalitis, and an immune-mediated postinfectious process, termed acute postinfectious measles encephalitis. Most descriptions come from children, and the presentation, pathogenesis, and management of adult disease remain poorly defined.  Case presentation: We describe four adults (aged 34–45 years) admitted with fever, rash, and altered mental status. Acute measles infection was confirmed by serum measles-specific IgM or measles virus RNA on real-time reverse-transcription PCR. Measles virus RNA was detected in cerebrospinal fluid in Case 1, indicating primary measles encephalitis. Case 2 was initially mistaken for varicella because of an atypical vesicular rash. Case 3 developed quadriparesis and sphincter dysfunction with electromyographic evidence of bilateral S1 radiculopathy; spinal imaging was not performed. Case 4 showed progressive thalamic and temporal lesions on magnetic resonance imaging. Cerebrospinal fluid pleocytosis ranged from 57 to 1046 cells/µL, and improved in most patients within 3 days of intravenous immunoglobulin. Two patients recovered without neurological sequelae, one survived with residual deficits, and one died from persistent cerebral injury complicated by multidrug-resistant septic shock.  Conclusions: In adults, acute measles encephalitis may reflect a biphasic process that combines direct viral neuroinvasion with immune-mediated inflammation, rather than a purely postinfectious phenomenon. Intravenous immunoglobulin was temporally associated with clinical and biochemical improvement, but its therapeutic role cannot be established from a case series and requires controlled study.
SN  - 1348-8945
SN  - 1349-4147
ER  -