Case Report: Paralytic rabies masquerading as traumatic spinal cord injury: a diagnostic pitfall in trauma surgery
- 1Department of Emergency Medicine, Institute of Disaster Medicine and Institute of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- 2West China School of Nursing, Sichuan University, Chengdu, China
- 3Precision Medicine Key Laboratory of Sichuan Province and Precision Medicine Center, West China Hospital, Sichuan University, Chengdu, China
Abstract
Rabies is a uniformly fatal zoonotic encephalitis. Its paralytic form, which accounts for approximately 20% of cases, frequently resembles acute spinal cord injury (SCI). When there is a coincident history of trauma, diagnostic anchoring may wrongly attribute neurological decline to the injury, thereby delaying the correct diagnosis. We describe the case of a 26-year-old man who developed progressive, ascending paralysis of the lower limbs 10 days after a 3-m fall. At a secondary hospital, he was clinically diagnosed with traumatic SCI without spinal MRI. On transfer, reassessment revealed a fox bite 4 months earlier and features of the hydrophobia variant (a sensation of water “entering the brain” during swallowing). Cerebrospinal fluid metagenomic next-generation sequencing (mNGS) detected Rabies lyssavirus within 48 h, showing 100% sequence identity to Chinese isolates spanning the N and L genes. This finding was subsequently confirmed by the Sichuan Provincial Center for Disease Control and Prevention (CDC) using standard reference testing on peripheral blood. The patient subsequently died of autonomic and respiratory failure. This case highlights how recent trauma can obscure a fatal infectious cause. A clinical diagnosis of SCI made without neuroimaging should be regarded as provisional, and mNGS can provide an unbiased, rapid means of resolving diagnostically challenging neurological presentations.
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BibTeX
@article{zhao2026case,
title = {{Case Report: Paralytic rabies masquerading as traumatic spinal cord injury: a diagnostic pitfall in trauma surgery}},
author = {Rui Zhao and Lian-Jing Liang and Si-Fen Lu and Rong Yao and Tao Cheng},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1954968},
url = {https://doi.org/10.3389/fmed.2026.1954968},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: Paralytic rabies masquerading as traumatic spinal cord injury: a diagnostic pitfall in trauma surgery
AU - Rui Zhao
AU - Lian-Jing Liang
AU - Si-Fen Lu
AU - Rong Yao
AU - Tao Cheng
PY - 2026
DA - 2026/10/13
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1954968
UR - https://doi.org/10.3389/fmed.2026.1954968
AB - Rabies is a uniformly fatal zoonotic encephalitis. Its paralytic form, which accounts for approximately 20% of cases, frequently resembles acute spinal cord injury (SCI). When there is a coincident history of trauma, diagnostic anchoring may wrongly attribute neurological decline to the injury, thereby delaying the correct diagnosis. We describe the case of a 26-year-old man who developed progressive, ascending paralysis of the lower limbs 10 days after a 3-m fall. At a secondary hospital, he was clinically diagnosed with traumatic SCI without spinal MRI. On transfer, reassessment revealed a fox bite 4 months earlier and features of the hydrophobia variant (a sensation of water “entering the brain” during swallowing). Cerebrospinal fluid metagenomic next-generation sequencing (mNGS) detected Rabies lyssavirus within 48 h, showing 100% sequence identity to Chinese isolates spanning the N and L genes. This finding was subsequently confirmed by the Sichuan Provincial Center for Disease Control and Prevention (CDC) using standard reference testing on peripheral blood. The patient subsequently died of autonomic and respiratory failure. This case highlights how recent trauma can obscure a fatal infectious cause. A clinical diagnosis of SCI made without neuroimaging should be regarded as provisional, and mNGS can provide an unbiased, rapid means of resolving diagnostically challenging neurological presentations.
SN - 2296-858X
ER -