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Correctly identifying Koplik’s spots is not an easy feat, as noted in Spitzer’s excellent letter.12 Koplik’s spots are still thought to be pathognomonic for measles, but oral lesions, similar in appearance to Koplik’s spots, can be found in other illnesses, such as parvovirus B12 infection.3 Zenner and Nacul’s study included reporting of “Koplik’s spots” by clinicians with variable levels of experience and did not include independent assessment …

What you need to know A 23 year old woman has fever, flu-like symptoms, diarrhoea, and a rash that has spread from her face to her body. She cannot recall being in contact with anyone unwell and has not recently travelled or taken any drugs. She reports missing vaccinations as a child because her parents were concerned about safety. On examination she has a maculopapular blanching rash on her face and chest. Measles was suspected and confirmed with serology that was positive for immunoglobulin M antibodies to the measles virus. Reverse transcription polymerase chain reaction on a throat swab detected measles virus RNA. Measles is widely perceived as a disease of early childhood, despite almost two thirds of recent cases in the United Kingdom being in those aged 15 and older.1 Patients typically present with fever, cough, coryza, and conjunctivitis, followed two to four days later by a characteristic erythematous maculopapular rash that spreads downwards from the face (figs 1⇓ and 2⇓).2 Patients are infectious from four days before to four days after the onset of rash. Koplik’s spots—whitish lesions …