A Case of Atypical Rabies with Adams-Stokes Syndrome ： a case report

Background: Rabies is an infectious disease of animal origin caused by Rabies lyssavirus, commonly known as the Rabies virus (RABV), and leads to acute encephalitis or meningoencephalitis. However, no single test is sufficient for a precise diagnosis. Moreover, the diagnosis of rabies is also difficult for individuals with atypical symptoms or multizonal failures, which lead to a higher rate of clinical misdiagnosis. Therefore, there is an urgent need to develop a sensitive method to diagnose such patients. Case presentation: We report a case of atypical rabies with Adams-Stokes syndrome. A 70-year-old male was admitted to hospital with vomiting for five consecutive days and recurrent loss of consciousness for three days. Electrocardiography monitoring showed frequent sinus arrest and third-degree atrioventricular block, suggesting Adams-Stokes syndrome. Percutaneous external noninvasive pacing therapy was immediately administered. On the third day of admission, the patient tested positive for RABV in bronchoalveolar lavage fluid (BALF) using metagenomic next-generation sequencing (mNGS). The patient then developed psychiatric symptoms such as convulsions and eventually deteriorated to multiple organ failure on the fifth day of admission. The patient’s disease developed rapidly after showing typical symptoms of rabies and the patient died on the same day that he voluntarily discharged. Conclusion We demonstrated that mNGS could be used as a complementary tool for diagnosing rabies, especially for individuals with unclear exposure histories or atypical symptoms.