Fatal rabies associated with extensive demyelination

To compare the clinical course with the neuropathological findings in a patient who died of acute rabies encephalomyelitis with coexisting demyelinating lesions.

Patient's history was extensively investigated, during her illness and after death. Details of her previous allergies, postexposure prophylaxis, early use of steroid therapy, 20-day course in an intensive care unit, and autopsy results are clinicopathologically correlated.

The intensive care unit of an 1100-bed tertiary referral center and teaching hospital.

A 55-year-old woman, referred by her family doctor.

Postvaccinal encephalomyelitis and rabies can run similar courses and can be misdiagnosed. On admission to the hospital, this patient was initially diagnosed as having postvaccinal disease. However, autopsy results and postmortem viral cultures disclosed a complex picture, including acute rabies and widespread perivenous demyelination. One other similar report from 1977 in the literature is reviewed. No adequate explanation of the rare coexistence of acute rabies encephalomyelitis and perivascular demyelination is available.