Severe ARDS without exanthem: atypical measles in advanced HIV

Measles remains a leading vaccine-preventable cause of viral pneumonia worldwide. In people with advanced human immunodeficiency virus (HIV) its course is often atypical, lacking the hallmark rash and progressing rapidly to respiratory failure. We report a case of measles virus-associated acute respiratory distress syndrome in a profoundly immunosuppressed woman with HIV and chronic hepatitis B who failed to respond to ribavirin. This case underscores the diagnostic challenge of rash-less measles in acquired immunodeficiency syndrome, the narrow therapeutic window for antivirals and the urgent need to integrate adult measles screening and vaccination into HIV care.