What does this research mean for the field?

Well-controlled HIV infection can predispose patients to atypical, rapidly progressive paralytic rabies, which may require repeated, highly sensitive CSF testing like mNGS for early diagnosis due to initially low viral loads. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This report describes the diagnostic challenges of rabies in an HIV patient with atypical symptoms.

May 31, 2026Open Access

A Case Report of Rabies in an HIV Patient: Diagnostic Challenges and Near-Miss Recognition

Puntos clave

This report describes the diagnostic challenges of rabies in an HIV patient with atypical symptoms.
Case report of a 53-year-old man with HIV presenting neurological symptoms.
Initial and follow-up cerebrospinal fluid (CSF) analysis using targeted and next-generation sequencing (NGS).
Assessment of clinical progression and response to diagnostic tests.
CSF mNGS detected 48 rabies virus reads on repeat testing compared to only 9 reads initially.
The patient exhibited rapid deterioration, showcasing the acute nature of the rabies progression.
Findings suggest that initial testing may miss rabies in patients with low viral loads, especially in immunocompromised individuals.

Resumen

Introduction: Rabies is a fatal viral zoonosis. It typically manifests as furious or paralytic encephalomyelitis. Diagnosis is challenging, especially with atypical presentations, low viral loads, or immunocompromise. HIV co-infection may further obscure the clinical picture. Case Presentation: A 53-year-old man with well-controlled HIV presented with dizziness, fever, and headache, then rapidly developed right hemiparesis, dysarthria, and behavioral changes. On day 3, he acutely deteriorated, developing quadriplegia, dysphagia, and mutism. Repeat CSF mNGS detected 48 rabies virus reads; reanalysis of the initial CSF sample revealed only 9. Conclusion: Early rabies diagnosis may fail when viral load falls below the detection limit of targeted assays such as tNGS. Even well-controlled HIV infection can predispose to atypical, rapidly progressive paralytic rabies. For acute encephalitis of unknown cause, clinicians should suspect rabies and repeat CSF testing using highly sensitive methods if initial tests are negative. Keywords: rabies, next-generation sequencing, HIV, diagnosis, encephalitis

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