Acute renal failure with neurological involvement in adults associated with measles virus isolation

Background Three people with clinical manifestations of acute renal failure with neurological involvement of unknown cause were admitted to a hospital in Mumbai, India. We describe clinical presentations and investigations of the cause. Methods We analysed case reports and laboratory findings for the patients ( age 37-43 years, two men, one woman) that were provided by the clinicians i n charge. Serum and cerebrospinal fluid were tested for viral cause by IgM ELISA to Japanese encephalitis, West Nile fever, dengue, and measles. Sampl es were inoculated in vero-cell culture for virus isolation. The virus isol ates were confirmed with indirect immunofluoresence with antimeasles immune sera and mouse monoclonal antibodies to measles HA and F proteins and with neutralisation tests using antimeasles immune sera. Findings Clinical features were fever, vomiting, oliguria or anuria, bilate ral facial weakness, impaired hearing, blindness, proximal and distal arefl exic limb paralysis, and respiratory paralysis. No patient had a macropapul ar rash. Blood urea nitrogen (4.64-27.8 mmol/L) and creatinine (601.1-1105. 0 mu mol/L) were high, and cerebrospinal fluid contained high concentration s of proteins and pleocytosis. Kidney biopsy samples in two patients showed severe interstitial nephritis, IgM antibodies to measles were found in blo od and cerebrospinal fluid. Vero-cell cultures from serum and cerebrospinal fluid of one patient and cerebrospinal fluid of two patients, showed cytop athic effects characteristic of measles. Interpretation Unusual manifestations of acute renal failure with neurologi cal involvement associated with measles virus in adults presenting without rash was confirmed. Our findings may affect the development of measles-elim ination programmes.