A case of subacute sclerosing panencephalitis in a 23-year-old recent immigrant to Australia
A 23-year-old woman presented with a generalised tonic–clonic seizure on a background of 9 months of progressive neurological decline (characterised by involuntary jerks, monocular visual disturbance and reduced speech) resulting in falls, impaired ability to perform activities of daily living and urinary incontinence. Examination showed right-sided myoclonus, bilateral parkinsonism, primitive reflexes present, akinetic mutism and retinal scarring apparent on fundoscopy.
Two years previously, she had migrated to Australia from the Philippines; her family reported that her neurodevelopment was normal and that she had received routine childhood vaccinations.
The results of computed tomography and angiography of the brain were normal. Magnetic resonance imaging of the brain showed cerebral volume loss and extensive white matter changes with ill-defined subcortical T2 hyperintensities. An electroencephalogram showed non-specific focal epilepsy disorder involving frontal regions. Results of extensive investigations for autoimmune, hereditary and infective causes were unremarkable with the exception of cerebrospinal fluid (CSF) analysis, which revealed unmatched oligoclonal IgG. Enzyme immunoassay of CSF and serum (with corrected optical density values of 2.24 and 4.21, respectively) gave a strongly positive result for measles IgG. Intrathecal measles antibody production was confirmed by the concurrent absence of varicella-zoster…