The introduction of measles vaccination programs and broad coverage worldwide 
has meant this infection a rare encounter for pediatricians. In Oman, with 
almost 100% measles vaccination coverage for children, this infection 
disappeared from the list of fever and rash differential diagnoses. Encephalitis 
is a well-known complication of measles infection and sometimes can be the only 
manifestation especially in adults. We report a seven-year-old Syrian immigrant 
who was admitted to the Royal Hospital, Muscat, with acute encephalitis 
secondary to wild measles infection. Although she had a classical presentation 
of measle infection, the diagnosis was missed in the private and regional 
hospital she attended before getting referred to Royal Hospital. She was later 
identified to be exposed to an outbreak of the infection in an unvaccinated 
population. Magnetic resonance imaging showed high signal intensity of both 
basal ganglia suggestive of measles encephalitis. The diagnosis was confirmed by 
detection of measles virus from her urine and blood, and a throat swab. The 
isolated measles virus was D8 serotype, which was prevalent in Syria around the 
same time. The child was treated with steroids and vitamin A. She achieved full 
recovery despite her severe presentation. A high degree of suspicion for measles 
infection should be maintained in unvaccinated children with a compatible 
presentation of the infection or its complications. There might be a role for 
steroid use in cases of acute measles encephalitis.