Fatal measles complication in the misinformation era: A case of catastrophically rapid SSPE in an unvaccinated child

Vaccine hesitancy, amplified by digital misinformation, represents a growing threat to global health. This case demonstrates its lethal consequences through rapid-onset subacute sclerosing panencephalitis (SSPE) in an unvaccinated 3.5-year-old girl whose parents refused measles-mumps-rubella (MMR) vaccination due to pandemic-amplified misinformation. A developmentally normal preschooler, vaccinated only at birth (BCG, oral polio vaccine, and hepatitis B vaccine), presented with head-drop seizures progressing to myoclonus and speech loss within weeks. Comprehensive diagnostic workup confirmed SSPE through fulfillment of Dyken's criteria, including characteristic clinical presentation, elevated measles-specific IgG in both CSF (titer 1:256 by ELISA) and serum (titer 1:128) with elevated CSF/serum antibody index (1.8), periodic complexes on EEG, symmetric white matter lesions on MRI, and exclusion of alternative infectious/autoimmune etiologies. Despite immunomodulatory therapy (intravenous immunoglobulins and ribavirin), she progressed to vegetative state by week 12, expiring at 4 months post-onset. Parental refusal of both vaccination and life-saving interventions reflected profound medical mistrust. Neuroimaging revealed rapid progression to diffuse atrophy within 6 weeks. MR spectroscopy showed marked reduction in N-acetylaspartate (NAA) and elevated lactate. This progression from symptom onset to death in 4 months represents one of the most rapid SSPE courses documented, highlighting the vulnerability of unvaccinated children and demonstrating how digital misinformation enables preventable tragedies. The case demands: (1) nuanced strategies to combat health misinformation, (2) heightened vigilance for fulminant SSPE in unvaccinated children, and (3) urgent reinforcement of measles vaccination programs. When vaccination rates decline, children become the tragic casualties of misinformation.