Atypical measles syndrome: pathologic and serologic findings.
Annunziato D, Kaplan MH, Hall WW, Ichinose H, Lin JH, Balsam D, Paladino VS.
The clinical course of measles occurring in 17 adolescents who had previously
received killed measles vaccine is described. All adolescents had a peripheral
dermatitis. Fifteen had characteristic pulmonary infiltrates. Serologic study in
six adolescents using immunoprecipitation of 35S-methionine-labeled measles
virus antigens revealed that 5/6 acute sera lacked antibody to the hemolysin
antigen whereas 5/6 sera contained antibody to hemagglutinin antigen. Skin
biopsies, obtained from three patients, demonstrate a combination of an Arthus
reaction and delayed hypersensitivity. The typical measles histologic complex
was absent. Measles virions were seen in the deep dermal blood vessels. The
serologic and histopathologic presentation of this disease indicates that killed
vaccine does not adequately induce antibody to the hemolysin (F) which is
necessary to prevent cell-to-cell spread of paramyxoviruses. Killed vaccine
does, however, produce hemagglutinin antibody and simultaneously incites later
hypersensitivity to wild virus infection, producing the unusual
dermatopathologic reaction seen.
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