The introduction of measles vaccination programs and broad coverage worldwide has meant this infection a rare encounter for pediatricians. In Oman, with almost 100% measles vaccination coverage for children, this infection disappeared from the list of fever and rash differential diagnoses. Encephalitis is a well-known complication of measles infection and sometimes can be the only manifestation especially in adults. We report a seven-year-old Syrian immigrant who was admitted to the Royal Hospital, Muscat, with acute encephalitis secondary to wild measles infection. Although she had a classical presentation of measle infection, the diagnosis was missed in the private and regional hospital she attended before getting referred to Royal Hospital. She was later identified to be exposed to an outbreak of the infection in an unvaccinated population. Magnetic resonance imaging showed high signal intensity of both basal ganglia suggestive of measles encephalitis. The diagnosis was confirmed by detection of measles virus from her urine and blood, and a throat swab. The isolated measles virus was D8 serotype, which was prevalent in Syria around the same time. The child was treated with steroids and vitamin A. She achieved full recovery despite her severe presentation. A high degree of suspicion for measles infection should be maintained in unvaccinated children with a compatible presentation of the infection or its complications. There might be a role for steroid use in cases of acute measles encephalitis.

A five years old Yemeni boy presented with a 5 months history of progressive neurological deterioration in picture of progressive cognitive decline , seizures and hyperkinetic movements. Patient came from an area with political instability and low socio-economic status. There was history suggestive of measles at 2 years of age. He never received measles vaccination. Diagnosis of sub acute sclerosing pan encephalitis (SSPE) was made based on clinical symptoms, serum and CSF findings of high measles IgG, neuroradiological findings as well as neurophysiological findings. We report this case to highlight the role of intravenous immunoglobulin and steroid in improving his symptoms.