In sight but out of mind

ABSTRACT Measles is a highly contagious, acute-onset, exanthematous disease that affects the respiratory tract and mucous membranes. The clinical case we reported highlights 2 important aspects of making a difficult clinical diagnosis. First, the patient did not recall her immunization history, and the clinical team did not clarify it, and thus potential childhood illnesses such as measles and rubella did not remain on the differential diagnosis. Assuming that a patient has had the appropriate vaccinations is done at the clinician’s—and the patient’s—peril. Second, many diseases that commonly afflict children can also occur in adult patients, albeit less frequently. Had this patient been a 5-year-old child with the same symptoms, the diagnosis would likely have been made with alacrity. However, maculopapular rashes that begin on the face and spread to the body are quite uncommon in adult medicine. For both discussant and the clinical team, the rash was clearly in sight but the correct diagnosis was out of mind given the rarity of this infection in adults. Fortunately, however, once it became clear that the patient was unlikely to have toxic shock syndrome, the epidemiological detail initially left behind became the sentinel clue necessary to solve the case.