SEVERE MEASLES PNEUMONITIS IN ADULTS - EVALUATION OF CLINICAL CHARACTERISTICS AND THERAPY WITH INTRAVENOUS RIBAVIRIN

Between February and April 1991, six adults were admitted to the New Y ork Hospital because of measles pneumonitis. The diagnosis was confirm ed by serology and/or viral culture. Uncommon clinical features among patients with this diagnosis included thrombocytopenia, hepatitis, myo sitis, and hypocalcemia. All patients were markedly hypoxic (initial a lveolar - arterial oxygen gradients while the patients were breathing room air, 40-61 mm Hg); four required support with mechanical ventilat ion. All patients received therapy with intravenous ribavirin (20-35 m g/[kg.d]) for 1 week. The respiratory status of five patients (one of whom was positive for human immunodeficiency virus [HIV]) who were tre ated early (days 2-5 of illness) promptly improved; all abnormal param eters eventually returned to baseline. Treatment of the sixth patient, who was presumed to be HIV-infected, was initiated on hospital day 22 ; this patient died of progressive oxygenation failure on day 38. We c onclude that life-threatening measles pneumonitis in adults may be mor e common than previously appreciated, regardless of the patient's immu ne status. Therapy with intravenous ribavirin was well tolerated by ou r patients and was associated with reversal of respiratory compromise.