A Rare Case of Paralytic Rabies; an Uncommon Presentation of a Daunting Disease

Rabies is a fatal zoonotic disease. Timely and complete post-exposure prophylaxis can prevent the disease. A 10-year-old boy presented with a history of fever and altered mentation for 6 days. There was no history of hydrophobia or aerophobia. The child had features of raised intracranial tension and hypotonia of all limbs with absent deep tendon reflexes. Parents revealed the history of an unprovoked dog bite on the right arm (category III) 1 month ago, for which he received 4 intramuscular doses of anti-rabies vaccine, but did not receive anti-rabies immunoglobulin. Based on this history, he was clinically diagnosed with paralytic rabies, and the diagnosis was confirmed by the presence of rabies antibody in cerebrospinal fluid. He was started on Milwaukee protocol, however the child succumbed after 10 days of hospital stay. This case report highlights the importance of history-taking to make a clinical diagnosis of rabies. Health care workers’ awareness is crucial for accurate categorization of the animal bite, and ensuring timely post-exposure prophylaxis.