Measles-Associated Myocarditis: A Case Report

Introduction: Measles is a highly contagious, potentially fatal, but vaccine preventable disease. In 2025, due to increased rates of unvaccinated individuals, there has been a surge of measles infections in Israel, especially among unvaccinated children who come from densely populated communities. Several of these children have required intensive care and one developed myocarditis requiring extracorporeal life support.


Description: A one-year-old unvaccinated female presented to the emergency room with 2 days of fever, weakness and coryzal symptoms with conjunctivitis. On exam, she demonstrated severe respiratory distress with tachypnea, retractions and desaturations, and tachycardia to 200. Her initial laboratory workup demonstrated hyperlactatemia (40 mg/dl), leukopenia (WBC 3.34K) and mildly elevated inflammatory markers. She was intubated shortly after admission to the PICU with subsequent hemodynamic compromise necessitating 3 high-dose vasoactive medications. Her chest X-ray demonstrated diffuse bilateral patchy infiltrates with an oxygenation index of 27. Echocardiography on admission demonstrated severely reduced biventricular function with moderate mitral and tricuspid regurgitation. In view of her high vasoactive need, she was cannulated to peripheral veno-arterial ECMO. On ECMO day 3, she underwent placement of a left atrial cannula for left heart decompression in view of pulmonary edema with bloody endotracheal tube secretions and loss of pulsatility in the arterial line. She was treated with intravenous immunoglobulin as immunomodulator. Within 3 days following decompression of the left heart, her pulmonary edema improved gradually with recovery of the cardiac function. Her ECMO run was complicated with right sided infarct in the internal capsule. The LA vent was removed on ECMO day 11.


Discussion: As rates of vaccination fall and cases increase, the pediatric intensivist must be prepared for the critical manifestations of measles infection. Myocarditis is a rare but life-threatening complication of acute measles infection. Timely recognition and appropriate management are necessary to improve the outcomes of these patients.