Case Reports Journal Article Epublish 1 citation
PubMed: 40641906 DOI: 10.1016/j.idcr.2025.e02305
Post anti-rabies vaccine encephalitis presenting as acute psychosis: Case reports.
IDCases 41:e02305
Authors: Birtukan Fasil, Mulualem Kelebie, Fanuel Gashaw, Abebayehu Sihalle, Seblewongel Shawel, Biruk Fanta, Gebrehiwot Lema Legese, Netsanet Gete, Guadie Beyazn
Affiliations
- Department of Psychiatry, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
- Department of Neurology, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
- Department of Pediatrics and Child Health, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Abstract
Rabies, an invariably fatal zoonotic disease, remains a major public health concern in resource-limited settings, where access to cell culture-derived vaccines constrained hampers comprehensive immunization programs and compromises effective disease control and prevention efforts. As a result, several countries, including Ethiopia, continue to utilize nerve tissue-derived vaccines (NTVs)-notably phenolized sheep brain formulations-despite their well-documented neurotoxicity and the global recommendation to transition to safer, cell culture-based alternatives. This report describes two clinically significant cases of severe neuroinflammatory syndromes temporally associated with the administration of nerve tissue-derived phenolized sheep brain rabies vaccine. The first involves a 50-year-old male who developed acute neuropsychiatric symptoms including agitation, confusion, hallucinations, ataxia, and profound sleep disturbances approximately two weeks after completing a full course of the nerve tissue anti-rabies vaccine. Magnetic resonance imaging (MRI) of the brain demonstrated bilateral, asymmetric hyperintensities on T2-weighted and FLAIR sequences involving the cingulate gyrus, basal ganglia, medial thalami, hypothalamus, and fornix, findings that are radiologically consistent with limbic encephalitis. The second case describes a previously healthy 4-year-old boy who experienced rapidly progressive quadriplegia, encephalopathy, and seizures following vaccination, with MRI findings characteristic of acute disseminated encephalomyelitis (ADEM), showing diffuse, symmetrical involvement of deep grey matter structures, brainstem, and cerebellar hemispheres. These cases show rare but serious central nervous system complications from nerve tissue rabies vaccines and highlight the urgent need to replace them with safer, WHO-recommended cell culture vaccines.
MeSH
Cells, Vaccines, Brain, Rabies, Tissues, Cell Culture Techniques, Encephalitis, Psychotic Disorders, Nerve Tissue, Rabies Vaccines