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Picture of the Month

Walter W. Tunnessen Jr, MD; Howard Markel, MD, PhD
Arch Pediatr Adolesc Med. 1996;150(5):547-548. doi:10.1001/archpedi.1996.02170300101020.
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FOLLOWING A 3-day history of fever, rhinorrhea, cough, and conjunctival injection, a 20-month-old boy developed the rash pictured in Figure 1. On the third day after the appearance of the rash, the lesions had become more confluent (Figure 2). Figure 3 and Figure 4 illustrate typical buccal mucosal lesions associated with this illness.

Denouement and Discussion 

Rubeola (Measles)  Before the development of the measles vaccine, rubeola was easily recognized by laypersons as well as by physicians. It was a ubiquitous, highly contagious disease that infected most of the population at some point during their lifetimes. Epidemics occurred almost yearly. Although there have been some sporadic breakthrough endemics of this infection in the last 2 decades, the clinical picture of measles is not well recognized by more recently trained physicians or the lay public. Failure to recognize early cases of this illness often leads to needless exposure of the unprotected, unimmunized,


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