POST-MEASLES ACUTE VELOPHARYNGEAL INCOMPETENCE: A RARE CASE REPORT AND REVIEW OF LITERATURE.

Summary/introduction: Velopharyngeal incompetence(VPI) is the failure of closure of the velopharyngeal sphincter, which consists of the muscles of the soft palate and the superior pharyngeal constrictor, and functions to separate the nasopharynx and oropharynx during phonation and swallowing. VPI is most frequently congenital/syndromic (with structural deficit) but can be acquired. A subset of acquired VPI, occurring in structurally intact velopharynx, has been described in children, and these are isolated and acute-onset, with a substantial proportion thought to have an infectious origin. So far measles was identified to be the aetiology in one reported case. This report aims to create awareness that VPI could be a rare post-measles complication.

Case report: A two-year-old female who, two weeks after a measles episode, developed sudden-onset nasal regurgitation, rhinolalia, and dysphagia. She had never experienced these symptoms before and has not had any recent throat surgeries. The review of systems was not contributory. On examination, she was ill-looking with no dysmorphic features; was not febrile or pale, and had generalized brownish-scaly, desquamating skin lesions. Nasal regurgitation of liquids was observed when she drank. Oral/oropharyngeal examination revealed no structural defects but she had absent gag reflex with bilateral palatal paralysis (indicating Glossopharyngeal and Vagus nerve palsies). All other neurological and systemic findings were normal. Management was conservative with a Nasogastric tube for feeding. She made a complete recovery with total restoration of neurologic functions after 21 days. Six-month follow-up revealed no recurrence or signs of progression.

Conclusion: This report adds to the evidence that measles is one of the infectious causes of acute-onset isolated VPI. The proposed mechanisms underlying this unusual manifestation of measles are direct viral neuronal injury given its neurotropic nature; and autoimmune neuronal injury. The reason for the rarity of this post-measles complication despite the high incidence of measles remains to be elucidated.