Survival Following Paralytic Rabies Encephalomyelitis in a Toddler: Challenges in Confirmation of Diagnosis

Rabies encephalitis, caused by rabies virus, is an almost uniformly fatal neurotropic infection once clinical disease develops. Classical presentations of furious rabies, typically associated with a definitive history of dog bite and characteristic features such as hydrophobia and aerophobia, progress rapidly to death. In contrast, atypical presentations, particularly paralytic rabies, often lack classical clinical features posing significant diagnostic challenges. Diagnostic confirmation may be further complicated by recent post-exposure vaccination, confounding antibody assays, while molecular detection remains technically demanding and limited in availability. With advances in intensive care, rare instances of survival have been reported, especially in children. The authors report the case of a 2-y-old toddler with history of dog bite, who presented with rapidly progressive quadriparesis, where the diagnosis of paralytic rabies was supported by rising CSF and serum rabies virus neutralising antibodies. The child survived following comprehensive intensive care and was successfully discharged after a six-week hospital stay.