Exanthem of measles and clues to its diagnosis: experience of a nosocomial outbreak in Taiwan

Taiwan has been experiencing a resurgence of measles since the beginning of 2009. We retrospectively reviewed the clinical presentations of eight confirmed measles cases during a nosocomial outbreak, in order to identify diagnostic clues. The exan-them was polymorphous and non-specific in terms of its morphology, distribution, sequence of appearance, and symptoms. The presence of cough and coryza as well as abnormal results of routine laboratory studies were also non-specific and unhelpful for the differential diagnosis of measles from other infectious diseases, adverse drug reactions, or autoimmune diseases. In our experience, the combination of exudative conjunctivitis with febrile exanthem is the most distinguishing feature of measles. Serologic studies can confirm the diagnosis within a few hours. Further measles outbreaks are possible in the near future as a result of increased international travel, immigration of foreign workers, and overseas marriages. Dermatologists must be proficient in the diagnosis of measles in order to prevent the potential morbidity and mortality associated with future outbreaks.