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The day after entering California from Oaxaca, Mexico, an undocumented 16-year-old male was brought to an emergency department with a sore throat and a recent history of not eating or drinking. He exhibited low-grade fever, tachycardia, agitation, and crying. Discharged after treatment with intravenous fluids, he returned several hours later with the same symptoms plus nausea, vomiting, frequent spitting, and refusal to take oral fluids. Again, he was discharged. The next day, he collapsed at home and could not be resuscitated.
Postmortem, rabies was considered, based on the patient's presentation and his emigration from an area with endemic canine rabies. Public health investigation revealed a history of a dog bite and a fox bite in Oaxaca …