Adult Rubella in a Returned Traveler

A previous healthy 48-year-old Japanese man presented to our hospital with a 3-day history of a high fever and rash. Ten days after returning from a one-week visit to Malaysia on a business trip, he developed a fever, chill, sore throat, runny nose, arthralgia and rash. The patient reported no pain behind the eyes, coughing or abdominal symptoms. He did not remember his immunization history well. On a physical examination, he had hyperemic conjunctiva (Picture 1) and left posterior cervical lymphadenopathy, and his rash had progressed to confluent erythematous papules on the face, trunk and extremities (Picture 2). Serum dengue NS1 antigen, parvovirus B19, and measles polymerase chain reaction (PCR) were negative, but serum and urine rubella PCR were positive. A fever and rash are common complaints in returned travelers (1). In Japan, a rubella outbreak occurred in 2013. Most of the reported cases were adult men 37-53 years of age who had not received routine rubella vaccinations as children (2). It is important to bear in mind that vaccine-preventable diseases such as rubella should be included in the differential diagnosis.