An 8-year-old child was bitten on the foot by a dog and received three doses of the rabies vaccine. One month after the bite, he developed fever and malaise, which progressed to altered mental status, drowsiness, and incoherent speech. Physical examination revealed a temperature of 39°C and increased muscle tone in all limbs with hyperreflexia. His neurological assessment showed a Glasgow Coma Scale (GCS) of 12/15. Given the suspected rabies encephalitis diagnosis, an MRI was performed.

MRI findings showed bilateral and symmetrical T2 and FLAIR hyperintensities in the lenticular nuclei, caudate nuclei, posterior thalami, and periaqueductal gray matter, with no diffusion restriction and no post-contrast enhancement. Additionally, two rounded signal abnormalities in the splenium of the corpus callosum displayed T2 and FLAIR hyperintensities, T1 hypointensities, and restricted diffusion, consistent with cytotoxic edema. Unfortunately, the patient passed away the day after the MRI.