Presentation with paraparesis and a forgotten dog bite: Lessons from a rabies case

Area of Science:

• Neurology
• Infectious Diseases

Background:

• Rabies, a viral zoonotic disease, can manifest atypically.
• Acute-onset flaccid paralysis occurs in approximately 20% of rabies cases.
• These paralytic rabies presentations can be misdiagnosed as Guillain-Barré syndrome (GBS).

Purpose of the Study:

• To highlight the diagnostic challenges in paralytic rabies.
• To emphasize the importance of considering rabies in cases of acute flaccid paralysis.
• To review the clinical features of paralytic rabies.

Main Methods:

• Review of clinical case presentations.
• Analysis of diagnostic criteria for paralytic rabies versus GBS.
• Literature review on atypical rabies presentations.

Main Results:

• A significant proportion of rabies cases present with flaccid paralysis, mimicking GBS.
• Hallmark rabies symptoms like hydrophobia and aerophobia are absent in nearly 50% of paralytic rabies cases.
• Delayed diagnosis can occur due to the absence of typical rabies signs.

Conclusions:

• Paralytic rabies presents a diagnostic challenge, often mimicking GBS.
• Clinical suspicion for rabies is crucial even without classic symptoms in paralytic presentations.
• Accurate diagnosis is essential for appropriate management and public health.