MRI as a key tool in presumptive antemortem diagnosis of rabies: A case report

Abstract

Rabies, a rapidly progressive and fatal viral encephalitis, can present a diagnostic challenge in its paralytic form, which can mimic Guillain-Barré syndrome (GBS) and delay diagnosis, especially when classic symptoms like hydrophobia and aerophobia are absent. We report the case of a 24-year-old woman with progressive bilateral leg weakness, urinary retention, and behavioral changes. She developed symptoms 1 month after a dog bite and 6 days after completing post-exposure prophylaxis (PEP), initially leading to suspicion of post vaccination Guillain-Barré syndrome (GBS) or ADEM. Despite supportive care, her condition worsened. Brain and spinal MRI revealed characteristic symmetrical T2/FLAIR hyperintensities in the bilateral basal ganglia, thalami, limbic system, brainstem, and central cervical spinal cord as seen in rabies encephalitis. This case highlights the diagnostic value of MRI in identifying rabies, particularly in atypical presentations and post-vaccination states.