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We report a case of measles virus\u2013associated acute respiratory distress syndrome in a profoundly immunosuppressed woman with HIV and chronic hepatitis B who failed to respond to ribavirin. This case underscores the diagnostic challenge of rash-less measles in acquired immunodeficiency syndrome, the narrow therapeutic window for antivirals and the urgent need to integrate adult measles screening and vaccination into HIV care.<\/jats:p>","DOI":"10.1093\/trstmh\/trag003","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T12:54:30Z","timestamp":1767963270000},"page":"411-413","source":"Crossref","is-referenced-by-count":0,"title":["Severe ARDS without exanthem: atypical measles in advanced HIV"],"prefix":"10.1093","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4536-7449","authenticated-orcid":false,"given":"Venkata Swathi Kiran","family":"Pothumarthy","sequence":"first","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal, Karnataka , 576104","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rathan","family":"Kamath","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal, Karnataka , 576104","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9687-2836","authenticated-orcid":false,"given":"Nitin","family":"Gupta","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Infectious Diseases, , Manipal, Karnataka , 576104","place":["India"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P S","family":"Priya","sequence":"additional","affiliation":[{"name":"Kasturba Medical College, Manipal Academy of Higher Education Department of Radiodiagnosis, , Manipal, Karnataka , 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