A rare case of paralytic rabies presented with acute flaccid transverse myelitis in case of inadequate post-exposure prophylaxis

Rabies is a fatal infectious disease caused by rabies lyssavirus, mainly transmitted to humans by the bite of rabid mammals. Rabies can present in encephalitic and paralytic types. Paralytic rabies presents with acute flaccid transverse myelitis. We report a rare case of paralytic rabies with inadequate post-exposure prophylaxis (PEP). A 19-year-old male was admitted with paraplegia and associated bladder and bowel incontinence for 2 days. He had history of Category III bite by a street stray dog and received inadequate PEP 3 months back which was revealed later. On imaging of dorsal spinal cord magnetic resonance imaging, there was a long-segment T2 and short-tau inversion recovery (STIR) hyperintense signal in central gray matter of dorsal cord with involvement up to part of conus medullaris. Cerebrospinal fluid analysis showed elevated microprotein with lymphocyte predominance. Clinical and laboratory findings supported diagnosis of rabies induced acute transverse myelitis. Incomplete PEP has been frequently reported in cases developing paralytic rabies. Adequate PEP according can easily prevent this disease.