Rabies Encephalitis on FDG PET CT: First Case of Metabolic Imaging in Rare Survivor

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Rabies is a viral zoonotic disease with a near-universal fatality rate.
• Survival is exceptionally rare, particularly after developing clinical symptoms.
• Incomplete post-exposure prophylaxis increases the risk of developing rabies.

Purpose of the Study:

• To report a rare case of rabies encephalitis survival in a pediatric patient.
• To describe the clinical presentation and diagnostic findings, including novel PET-CT imaging.
• To contribute to the understanding of rabies encephalitis progression and potential long-term effects.

Main Methods:

• Case report of an 8-year-old girl with a category III dog bite.
• Clinical assessment including neurological examination, MRI, and PET-CT.
• Review of medical history, treatment received, and clinical course.

Main Results:

• The patient developed hydrophobia, aerophobia, seizures, and altered sensorium, consistent with rabies encephalitis.
• MRI revealed findings indicative of rabies encephalitis.
• PET-CT demonstrated cerebral and cerebellar atrophy with encephalitic changes, representing the first reported PET-CT findings in rabies encephalitis.

Conclusions:

• This case underscores the extreme rarity of rabies survival.
• PET-CT imaging can reveal significant neuropathological changes in rabies encephalitis.
• Further research is needed to understand the mechanisms of survival and long-term outcomes in rabies.