ATYPICAL RUBELLA PRESENTATION IN AN IMMUNOCOMPROMISED CHILD: A CASE REPORT AND DIAGNOSTIC CHALLENGES

Abstract

Viral exanthems in immunocompromised children can present with atypical features, complicating diagnosis and management. This case report highlights the diagnostic challenges and atypical clinical course of rubella in an immunocompromised paediatric patient with systemic lupus erythematosus (SLE) and macrophage activation syndrome (MAS). A 7-year-old girl with SLE-associated MAS presented with a 2-week history of high-grade fever and generalized maculopapular rash. Initial differentiation between rubella and measles was complicated by overlapping features. Key distinguishing findings included posterior auricular lymphadenopathy and timing of rash emergence. Notably, her immunosuppressed state due to SLE and MAS masked classic rubella symptoms, prolonging diagnostic uncertainty. Rubella infection was confirmed via serology (rubella-specific antibody). Despite severe immunosuppression, her condition stabilized with conservative care, optimised immunosuppressive therapy and nutritional support. No secondary complications were observed. This case illustrates rubella’s potential for atypical and severe manifestations in immunocompromised children, particularly those with concurrent autoimmune and hyperinflammatory conditions like SLE-MAS. It underscores the need for meticulous evaluation in high-risk populations, especially those who have not been vaccinated. This report contributes to understanding viral exanthems’ variable phenotypes in immunocompromised hosts, advocating for tailored diagnostic protocols in such cases.