Clinically Suspected Acute Post-Measles Encephalitis Complicated by Paracetamol-Induced Hepatotoxicity in an Unvaccinated Child: A Case Report from a Resource-Limited Setting

Abstract

Introduction: Measles remains a major cause of childhood morbidity and mortality in settings with low vaccination coverage. Although most cases are self-limited, severe neurological complications can occur, including post-measles encephalitis, which may be life-threatening and diagnostically challenging in resource-limited settings. Case Presentation: We report an unvaccinated young child who developed a clinical syndrome most consistent with acute post-measles encephalitis after a typical measles illness characterized by fever, maculopapular rash, conjunctivitis, cough, and household exposure. The child later presented with seizures and altered consciousness. Laboratory evaluation showed anemia, elevated inflammatory markers, and markedly elevated liver enzymes in the setting of supratherapeutic paracetamol exposure. Because cerebrospinal fluid analysis and magnetic resonance imaging were not available, the diagnosis was made clinically based on the history, timing of neurological deterioration, and exclusion of major structural intracranial pathology on brain computed tomography. The patient was treated with supportive intensive care, empirical antimicrobial and antiviral therapy, vitamin A, intracranial pressure management, and intravenous N-acetylcysteine, with complete neurological recovery. Conclusion: Acute post-measles encephalitis should be considered in unvaccinated children who develop new neurological symptoms after recent measles illness. This case highlights the importance of early clinical recognition, routine measles immunization, and safe fever management, including careful weight-based paracetamol dosing and caregiver counseling in resource-limited settings.