Fatal case of rabies viral infection in a 6-year-old boy: importance of adequate immunoglobulin administration

Background Rabies is a fatal zoonotic disease, caused by a lyssavirus, that affects people primarily worldwide with a high mortality rate, and domestic dogs are the pathogenic source of infection. In this article, we elucidate the diagnostic methodology and therapeutic regimen employed in the management of a patient who developed rabies syndrome following a dog bite. Case presentation A 6-year-old boy in Khuzestan, Iran, sustained a severe left cheek laceration involving the fascia, facial muscles, and oral cavity after being bitten by a stray dog. Despite prompt medical attention and wound debridement, the patient developed symptoms including fever, headache, nausea, and vomiting, as well as neurological signs such as fear, auditory and behavioral hallucinations, and spasms. MRI depicted heightened T2/FLAIR signals, suggesting brainstem encephalitis. PCR results are typically interpreted as” positive for rabies RNA by PCR”. The patient received multiple treatments, including anticonvulsants, sedatives, and antibiotics, but unfortunately passed away after 12 days of hospitalization. Despite post-exposure prophylaxis being available, our patient died from rabies. A critical factor contributing to the poor outcome was that the patient received only one-eighth of the standard immunoglobulin dose. Conclusion This case highlights the importance of prompt medical attention, serial testing, and appropriate treatment in patients suspected of rabies encephalitis.