Paroxysmal cold haemoglobinuria following measles immunization.

Paroxysmal Cold Haemoglobinuria Following Measles ImmunizationImmunization with live attenuated measles vaccine is generally considered to be a safe procedure, and though a mild measles-like illness may follow immunization, severe reactions are rare (Dudgeon, 1969).Paroxysmal cold haemoglobinuria has pre- viously been reported in association with natural measles infection (Dacie, 1954; O'Neill and Marshall, 1967); we report here a case after measles immunization.Case Report Our patient was a 19-month-old girl who, 6 weeks before her admission, was immunized with live attenuated measles vaccine (Schwarz strain, Glaxo Laboratories Ltd.). 3 weeks later she developed a mild illness with a morbilliform rash, conjunctivitis, and rhinorrhoea; this was complicated by bronchitis, and over the week before admission she became increasingly ill with anorexia, vomiting, and haemoglobinuria.There was no history of exposure to natural measles infection.On admission she was pale and lethargic, but there was no lymphadenopathy, hepatosplenomegaly, or jaundice.Hb was 3*3 g/100 ml, WBC 33,000/ul (neutrophils 44%, lymphocytes 450/o, metamyelocytes