Maculopapular rash and Koplik's spots in adult measles

Abstract

A 29-year-old man presented with a fi ve-day history of high fever, cough, coryza, conjunctivitis, and diarrhea. One day before admission, a maculopapular rash had developed on his head and face, and spread to his upper torso and shoulders. Physical examination revealed confl uent maculopapules on his trunk ( Figure A) and Koplik's spots on the buccal mucosa ( Figure B), both indicative of measles. The diagnosis was later confi rmed by the presence of anti-measles immunoglobulin M (IgM) antibodies. T he patient was treated with supportive care and he recovered uneventfully. The measles rash is believed to be caused by a hypersensitivity reaction. This characteristic rash appears fi rst on the face and the back of the ears, and then rapidly spreads in a centrifugal manner to the trunk, where it frequently becomes confl uent, and fi nally spreads to the extremities. Koplik's spots are highly characteristic of the prodromal phase of measles. These evanescent white or grey specks classically present on the buccal mucosa opposite the second molars early in the course of measles, and have been regarded as a pathognomonic feature of measles. Occasionally, they extend to the entire buccal mucosa. Koplik's spots have been reported in 60-70% of the patients, but are probably present in most people who develop measles. They can often be detected through careful obs ervation and can lead to the diagnosis of measles even before the onset of the rash. In conclusion, prompt recognition of the maculopapular rash and Koplik's spots can help in the early diagnosis of measles, which in turn can aid in limi ting the transmission of the disease, impl ementing early isolation measures, and administering prompt post -exposure vaccination to close contacts.

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

“…Koplik's spot was considered as a pathognomonic sign of measles virus infection [35,62,63]. In this study, the specificity and positive predictive value of Koplik's spot were both 100%.…”

Adult Measles – Case Reports of a Highly Contagious Disease

“…The disease is characterised by fever, followed by cough, coryza, and conjunctivitis. After 3 days of fever, the measles rash appears with small white Koplik’s spots on the buccal mucosa [3], [4] and maculopapular erythema, which starts on the face and spreads quickly to the trunk and the extremities [5]. Common complications include pneumonia, diarrhoea, middle ear infection, and central nervous system symptoms including seizures or encephalitis [6].…”