Progressive neurological decline in a measles survivor: A case report of subacute sclerosing panencephalitis in Zambia.

We report a case of subacute sclerosing panencephalitis in a 14-year-old boy who presented to specialized care 17 months after the onset of symptoms, at advanced disease stage with cognitive decline, seizures, myoclonus and dystonia. A history of infantile measles, combined with characteristic electroencephalography, neuroimaging, and elevated cerebrospinal fluid measles IgG levels, confirmed the diagnosis. The prolonged delay to presentation, driven by barriers to healthcare access, limited community and provider awareness of subacute sclerosing panencephalitis, and social stigma resulted in presentation at stage 3 disease and precluded any meaningful therapeutic interventions. Additionally, empirical antituberculosis therapy was initiated despite negative cerebrospinal and stool GeneXpert MTB/RIF results, illustrating the diagnostic anchoring that occurs in tuberculosis endemic settings. This case highlights the critical importance of early recognition of subacute sclerosing panencephalitis, the need to strengthen healthcare access and neurological diagnostic capacity in resource limited settings and the risk of empiric treatment practices that may delay appropriate diagnosis and management. With the global resurgence of measles, increased awareness and surveillance for subacute sclerosing panencephalitis in high-burden settings are essential.