FATAL MEASLES INFECTION IN A PATIENT WITH LOW-GRADE MALIGNANT NON-HODGKIN-LYMPHOMA

History and clinical findings: A 35-year-old man, for 6 years known to have non-Hodgkin lymphoma (NHL) was admitted because of deteriorating general condition, drowsiness and 11 days of flu-like symptoms. A gen eralized rash had been noted 5 days after onset of symptoms. His 2-yea r-old son had fallen ill with measles a fews days earlier. The patient had reportedly had measles as a child. On admission a generalized ras h was found, he had a fever of 40.5 degrees C, tachypnoea, conjunctivi tis and possible meningismus. Investigations: Lactate dehydrogenase ac tivity was raised to 458 U/ml, and C-reactive protein to 240 mg/ml. Ce rebrospinal fluid contained 8/3 cells and protein of 269 mg/l. The che st radiogram revealed opacification in the left upper lobe. Computed t omography of the skull demonstrated a pansinusitis. Diagnosis, treatme nt and course: As measles encephalitis seemed unlikely he was treated for the measles superinfection of bacterial pneumonitis (measles RNA i n the bronchoalveolar ravage) and the sinusitis with broad-spectrum an tibiotics. After initial improvement artificial ventilation had to be begun on day 3 because of an acute respiratory distress syndrome, diag nosed both clinically and radiologically. Despite additional antiviral and intensive medical treatment he died on day 11. Conclusion: Patien ts with impaired immunocompetence due to NHL may lose their immunologi cal ''memory'' for a previous measles infection. Prevention of exposur e may therefore be necessary, in addition to early hyperimmunoglobulin administration.