A case of rabies encephalitis: new dog, old tricks.

A 41-year-old Canadian man presented with a 1-week history of new bizarre behavior including agoraphobia. Nested PCR confirmed the presence of rabies in both nuchal snips and saliva. An initial MRI with gadolinium enhancement was normal. On day 8, repeat neuroimaging revealed new cranial nerve enhancement and slight hyperintensities of the caudate nuclei bilaterally (figure). This is consistent with cranial nerve involvement reported in animal studies1 and with a remote report of electron microscopic evidence of rabies virus in trigeminal ganglion cells reported in 2 human cases.2