MRI findings in human rabies: A case report on the importance of neuroimaging when biological tests are inconclusive

Rabies is a rare but fatal viral infection affecting the central nervous system, often presenting with nonspecific symptoms that can delay diagnosis. We report the case of a 14-year-old boy who presented with fever, headache, neck stiffness, photophobia, and convulsions, initially mimicking other central nervous system infections. Brain and spine MRI revealed hyperintense signals in the bilateral basal ganglia, thalami, limbic cortex and brainstem on T2-weighted and FLAIR images, without restricted diffusion on diffusion-weighted imaging and an MR spectroscopy consistent with rabies encephalitis. Spinal cord MRI showed an hyperintense signal that resolved on follow-up imaging after one month. This case highlights the role of MRI in detecting early neuroimaging changes in rabies encephalitis and underscores the need for clinical correlation for timely diagnosis and management. Further studies are needed to better define the utility of MRI in rabies encephalitis.