Patient: Michigan man
Symptoms: About five weeks after a man underwent a left kidney transplant at an Ohio hospital, he began experiencing tremors, leg weakness, urinary incontinence, and even confusion.
you may like
Diagnosis: The man’s doctors suspected that his signs and symptoms were indicative of rabies infection and consulted the Ohio Department of Health and the U.S. Centers for Disease Control and Prevention (CDC). Various clinical samples taken from the patient were sent to the CDC for testing and ultimately tested positive for rabies RNA, the genetic material of the virus, as well as antibodies to the virus.
Treatment: The patient died of the infection within 1 week of admission. Once infected with rabies, there is no effective treatment. There are only about 30 reports of people surviving symptomatic rabies in the medical literature, and doctors have not yet been able to reliably reproduce this result. That’s why rabies is almost always fatal.
(People who suspect they may have been infected with rabies, such as those who have been bitten by an animal, can be treated with anti-rabies antibodies or vaccines to prevent the virus from triggering an infection in the first place. This preventive treatment is highly effective.)
What’s unique about this case: The man’s rabies infection, the first reported in Michigan in about 15 years, is suspected to be potentially related to an organ transplant, according to the case report. Researchers had ruled out direct exposure to animals as a source of infection.
Upon learning of the suspected infection, CDC and partners at the state and local level began investigating possible contamination of the donor kidney. Donner is from Idaho, and investigators have contacted Donner’s family.
“In late October 2024, a skunk approached the donor who was holding a kitten in an outbuilding on a rural property,” the report states. “During the encounter in which the skunk rendered him unconscious, Donner scratched his shin and bled, but did not believe he had been bitten. According to the family, Donner believed the skunk’s behavior was due to a predatory attack on the kitten.”
Five weeks after the scratch, the donor began experiencing symptoms consistent with rabies, including confusion, difficulty swallowing, hallucinations and a stiff neck, the family said. Afterwards, he lost consciousness at home, was resuscitated and hospitalized, but never woke up. He was declared brain dead and removed from life support five days later.
you may like
Remarkably, the hospital staff who treated the donor did not initially notice the skunk scratch and thought his symptoms were due to a chronic disease rather than rabies. That being said, they took various clinical samples from patients, which the CDC retroactively tested for the virus.
A biopsy from the donor’s right kidney came back positive, but there was not enough sample from the left kidney for testing. Nevertheless, this supported the idea that the donor kidney was the likely source of the Michigan man’s rabies.
“This is the fourth case of transplant-transmitted rabies reported in the United States since 1978,” the case report states. “However, the risk of transplant-transmitted infections, including rabies, is low.” That means this sequence of events is highly unlikely, and hospitals follow extensive protocols to prevent infected organs from being transplanted into patients.
For more interesting medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and does not provide medical advice.
Source link
