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Fatal rabies associated with extensive demyelination

D A Nelson1, R G Berry

  • 1Medical Center of Delaware, Wilmington.

Archives of Neurology
|March 1, 1993
PubMed
Summary

This case study highlights how rabies and postvaccinal encephalomyelitis can present similarly, leading to misdiagnosis. Autopsy revealed coexisting rabies and demyelination, a rare finding.

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Area of Science:

  • Neurology
  • Pathology
  • Infectious Diseases

Background:

  • Rabies encephalomyelitis and demyelinating diseases present overlapping clinical symptoms.
  • Early diagnosis and treatment are crucial for rabies and demyelinating disorders.

Observation:

  • A 55-year-old woman presented with symptoms initially suggestive of postvaccinal encephalomyelitis.
  • The patient underwent a 20-day intensive care unit stay.
  • Clinicopathological correlation was performed, including autopsy and viral cultures.

Findings:

  • Autopsy and postmortem viral cultures confirmed acute rabies encephalomyelitis.
  • Widespread perivenous demyelination was also identified, a rare co-occurrence.
  • The patient's initial diagnosis was postvaccinal disease, underscoring diagnostic challenges.

Implications:

  • This case underscores the potential for misdiagnosis between rabies and postvaccinal encephalomyelitis due to similar clinical courses.
  • The rare coexistence of rabies encephalomyelitis and perivascular demyelination warrants further investigation.
  • Review of similar historical cases emphasizes the diagnostic complexity and rarity of this presentation.

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