Objective: Rabies encephalitis following a rabid dog-bite is considered a fatal disease. Prolonged survival in children with rabies encephalitis has only been anecdotally reported.

Methods: An 11-year-old boy presented with right hand paraesthesia followed by flaccid weakness of right limb, progressive encephalopathy, mutism and quadriparesis for the past 2 weeks. He had unprovoked, class III dog bite over the right wrist 1 month back. He had received 5 doses of Rabies vaccine. Examination showed encephalopathy (Glasgow Coma Scale 6), sluggish pupillary reaction, flaccid quadriparesis followed later by rigidity and intermittent dystonia.

Results: Cerebrospinal fluid (CSF) showed 61 cells, glucose 78 mg/dL and proteins 92 mg/dL. Magnetic resonance imaging of the brain showed pontine, thalamic, mid brain, basal ganglia and hippocampus hyperintensities. Anti-rabies neutralizing antibody titres rose from 1:32,768 to 1:1,31,072 in the serum; CSF antibody titres were >1:2048. CSF rabies RNA PCR was negative. He received supportive care, antimicrobial therapy for nosocomial infections, intravenous Acyclovir, Simvastatin, intravenous Methylprednisolone and Immunoglobulin. He improved to a minimally conscious state and remained static. He was discharged after 1.5 month of Hospital stay. At 3 weeks of follow-up, he is bed-bound with static neurological course, tracheostomized airway and nasogastric feeding.

Conclusion: Our paper presents a patient who survived rabies encephalitis following a stray dog bite, although with severe neurological residua. Brachial plexitis following local viral infiltration and spread is a rare presentation of dumb rabies.

Acknowledgment: Dr. Rodney Willoughby