Abstract 917

For a variety of reasons, adoption of children from developing countries has become increasingly common in the United States. Until recently, serious infections such as HIV, tuberculosis or hepatitis B, frequently remained undiscovered until after the adoption procedures were completed and the child was placed with a new family in the U.S. We report a fatal neurologic infectious disease which appeared in an internationally adopted child 7 years after his arrival in the U.S. Prior to his adoption at the age of 4 ½ years by an American couple, the child had lived in an orphanage in Thailand. At the time of adoption, the child appeared healthy. No history of measles was reported to the adoptive parents. The child remained well until the age of 13 years when he developed abnormal involuntary movements and academic decline. Examination revealed myoclonus, cogwheeling, gait disturbances, ocular motility abnormalities, and language deficits. Brain MRI demonstrated a focal area of increased signal intensity involving the subcortical white matter. A burst-suppression pattern was evident on EEG. Anti-rubeola antibody titers were markedly elevated in CSF and serum. Diagnosed with SSPE, the child became increasingly demented and died 1 year following onset of symptoms. This case highlights the value of the MMR vaccine, which has virtually eliminated SSPE in the U.S., and documents that SSPE is an unappreciated risk in children adopted from countries in which natural measles frequently occurs during the first 2 years of life.