Human Rabies with Initial Manifestations that Mimic Acute Brachial Neuritis and Guillain-Barré Syndrome.

Clinical Medicine Insights. Case Reports
Edward C MaderAustin J Sumner

Abstract

Human rabies can be overlooked in places where this disease is now rare. Its diagnosis is further confused by a negative history of exposure (cryptogenic rabies), by a Guillain-Barré syndrome (GBS) type of presentation, or by symptoms indicating another diagnosis, eg, acute brachial neuritis (ABN). A 19-year-old Mexican, with no past health problems, presented with a two-day history of left shoulder, arm, and chest pain. He arrived in Louisiana from Mexico five days prior to admission. Of particular importance is the absence of a history of rabies exposure and immunization. On admission, the patient had quadriparesis, areflexia, and elevated protein in the cerebrospinal fluid, prompting a diagnosis of GBS. However, emerging neurological deficits pointed towards acute encephalitis. Rabies was suspected on hospital day 11 after common causes of encephalitis (eg, arboviruses) have been excluded. The patient tested positive for rabies IgM and IgG. He died 17 days after admission. Negri bodies were detected in the patient's brain and rabies virus antigen typing identified the vampire bat as the source of infection. Rabies should be suspected in every patient with a rapidly evolving GBS-like illness-even if there is no history of exp...Continue Reading

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Citations

Apr 23, 2013·Lancet Neurology·Thiravat HemachudhaJiraporn Laothamatas
Dec 3, 2014·The American Journal of Emergency Medicine·Rajendra Singh JainMahendra S Sisodiya
May 10, 2013·PLoS Neglected Tropical Diseases·Philippe CarraraPhilippe Gautret

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Methods Mentioned

BETA
nucleic acid amplification

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