From initial suspicion to accurate diagnosis: unmasking rabies in a case of suspected Guillain-Barre syndrome.

Background: Rabies is a fatal viral infection with clinical presentation that can mimic other neurological disorders, such as Guillain-Barre Syndrome (GBS). Both conditions can present in early stages with same signs, including muscle weakness and paralysis, leading to diagnostic confusion. In this case report, we present a patient residing in Palestine who was initially diagnosed with GBS but was later found to have rabies. Early diagnosis of rabies is important because once clinical symptoms appear, the disease almost fatal. This case highlights the importance of increased awareness and consideration of rabies in differential diagnoses, especially in areas where the disease is endemic.

Case Presentation: We describe an 8-year-old male patient presenting with bilateral lower limb weakness, areflexia, urinary incontinence, and progressive respiratory decline, leading to intubation and mechanical ventilation. A lumbar puncture indicated elevated protein and zero cells, Brain and spinal MRI revealed enhancement of the cauda equina roots consistent with GBS. Despite treatment with intravenous immunoglobulin (IVIG), his condition worsened. Rabies was suspected after a history of a stray dog scratch two months prior and a nuchal biopsy confirmed the diagnosis. The patient's condition worsened, and he developed seizures, heart block, and cardiorespiratory arrest, leading to death on hospital day 17.

Conclusion: This case emphasizes the need to include rabies in the differential diagnosis for patients with rapidly worsening neurological symptoms, especially in endemic areas. Early detection of rabies is crucial as its progression is rapid and fatal, highlighting the importance of early intervention and post-exposure prophylaxis for individuals at risk.