Rabies presenting as acute psychiatric behavioral abnormality with delayed onset after dog bite: A fatal case report

Rabies is an overlooked zoonotic disease caused by neurotropic viruses of the genus Lyssavirus (family Rhabdoviridae), most commonly rabies virus (RABV) The incubation period for the RABV typically ranges from 20 to 90 days. We report a fatal case of rabies encephalitis initially manifesting as acute psychiatric behavioral abnormalities, with symptom onset one year after an untreated dog bite. A 45-year-old male was involuntarily brought to a psychiatric hospital. Initially, he exhibited various psychiatric and behavioral abnormalities. Over two days, his symptoms escalated. Initial differential diagnoses including substance abuse were excluded based on clinical progression. After intravenous administration of diazepam and ribavirin, his symptoms showed slight improvement. Further investigation into the medical history revealed that he was bitten by a dog one year ago, without receiving rabies vaccination. He ultimately died. In conclusion, it is essential to enhance awareness of rabies, particularly concerning the psychological and behavioral manifestations.