Unfavorable Outcome of Rabies Encephalitis in a Vaccinated Child: Neuroimaging Correlates

Rabies is a fatal viral encephalitis that remains a major health concern in endemic regions. A 4-year-old boy developed neurological symptoms 2 weeks after a category III dog bite, despite receiving immunoglobulin and three vaccine doses. Magnetic resonance imaging (MRI) showed T2/fluid-attenuated inversion recovery hyperintensities in the posterior lentiform nucleus, bilateral thalami and dorsal brainstem without diffusion restriction. Spine MRI revealed a long-segment cervical cord expansion with long-segment T2 hyperintensity. Rabies virus RNA was confirmed by reverse transcription-polymerase chain reaction from a skin biopsy. The child's condition worsened rapidly and proved fatal. This case underscores the importance of recognizing MRI features of rabies encephalitis, even in vaccinated children, to aid early diagnosis, guide clinical decisions and strengthen public health measures in endemic areas.