Measles Hepatitis in Two Patients with Ichtyosis Vulgaris: A Case Report

Abstract

Measles (Rubeola) is an acute infectious disease. The infectious agent is measles virus, a member of the genus Morbillivirus of the family Paramyxoviridae. The most frequent complications of measles are otitis media and pneumonia. Central nervous system complications of measles include acute measles encephalitis and subacute sclerosing panencephalitis. Measles virus causes temporal liver injury, myocarditis, sinusitis, bronchiolitis, appendicitis, subacute emphysema, pneumomediastinum, corneal ulcers, and thrombocytopenic purpura. Rubeola is not a usual cause of hepatitis. However, liver involvement is a possible complication of measles especially in young adults. Increasing number of unvaccinated people coming to Turkey may lead to new cases of measles infection. In this report, we present two siblings with measles with liver involvement. Interestingly, they had concomitant familial ichthyosis vulgaris. Ichthyosis vulgaris is an autosomal dominant disease. Widespread desquamation is observed in ichthyosis vulgaris. For this reason, dermatologic finding of measles were masked with erythema and desquamation at first. Moreover, the first patient had no history of contact with individuals with measles. Both patients had fever, headache, cough, red eyes, weakness and widespread rash over the body. The first patient who had been followed up with the diagnosis of ichthyosis vulgaris since childhood, admitted the dermatology clinic with the complaints of generalized erythema. He did not take any medication for ichthyosis vulgaris. His sister and brother had the same disease. The patient was referred to the infectious diseases clinic for consultation because he had fever and other complaints. We had difficulty to establish the diagnosis of measles especially in case 1 who had elevated liver enzymes and masked skin rashes. Even though maculopapular skin appearance was masked by desquamation at the beginning, we detected measles-specific immunoglobulin M (IgM) that we requested for the differential diagnosis of febrile and eruptive diseases. After a short period of time, similar complaints arose in his brother who came to visit his elder brother from another city. Maculopapular rash was more prominent and liver enzymes were higher in the second patient. Rubeola IgM was also positive in the positive in the second case. Clinical condition was improved and the liver enzymes decreased to normal level in both patients during follow-up. In this paper we aimed to draw attention to measles and liver involvement in adult measles cases.

Keywords

• Rubeola
• hepatitis
• ichthyosis vulgaris
• complication