Targeted next-generation sequencing confirms rabies in a patient with unknown exposure: a case report

This report describes a confirmed rabies case with no clear exposure history. A 68-year-old female was hospitalized due to chest tightness and shortness of breath, subsequently developing typical symptoms including agitation, photophobia, and hydrophobia, requiring transfer to the ICU. The family denied any animal bite history, and physical examination revealed only superficial marks on the left knee. Probe-capture targeted next-generation sequencing (tNGS) of bronchoalveolar lavage fluid (BALF) detected 279 rabies virus sequences, confirmed by Sanger sequencing. The patient ultimately succumbed to circulatory and respiratory failure after the family withdrew life support. This case demonstrates that probe-capture tNGS can serve as an effective tool for diagnosing rabies in living patient without typical exposure using BALF samples.