Abstract

Rabies is an acute, fatal viral infection of the central nervous system, and one of the oldest zoonotic diseases in human history. A Syrian boy aged 14 had been hospitalized for 2 days with a preliminary diagnosis of Guillain-Barre syndrome because of muscle weakness that spread rapidly to the upper extremities. He was transferred to our unit when the muscle weakness worsened. Respiratory failure developed following admission to the ICU, and the patient was intubated and given ventilator support. Ascending paralysis and albuminocytologic dissociation in the cerebrospinal fluid (CSF) examination suggested a preliminary diagnosis of Guillain-Barre syndrome and plasmapheresis treatment was initiated. No clinical improvement was achieved despite plasmapheresis. On the 10th day of hospitalization, we learned that he had been bitten on the ankle by a stray dog in Syria 2 months ago and had not received prophylaxis. Suspecting that this might be a case of rabies, body fluid samples of the patient were sent to the National Reference Laboratory. The patient died on the 12th day of admission. A postmortem brain biopsy was taken, and Negri bodies were detected.
This case report emphasizes that rabies should be considered in the differential diagnosis of patients presenting with paralysis.

Key words: Rabies; Guillain-Barre Syndrome; Encephalomyelitis.