Background: Measles is a highly infectious vaccine preventable viral disease that runs a devastating course in developing countries due to its association with malnutrition and poor immunization coverage. Among the complications of measles, pneumonia accounts for most measles-associated morbidity and mortality. However, subcutaneous emphysema is a rare complication of measles that can be challenging to manage and may portend poor outcome if untreated. Case presentation: We present a case of a 2yr old un-immunized rural dweller with massive subcutaneous emphysema comorbid with malnutrition complicating convalescent stage of measles. The child failed to improve with conservative management but responded to closed thoracostomy tube drainage (CTTD) through an underwater seal bottle with intermittent negative pressure wound therapy (NPWT). The child spent 47days on admission during which the treatment was supported by faith-based organization and social welfare unit of the hospital.ConclusionSubcutaneous emphysema is a rare complication of measles infection that can be challenging to manage especially when comorbid with malnutrition in an indigent child. Multi-disciplinary team approach and the use of CTTD with NPWT is an effective management measure which can shorten the duration of hospital stay.