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In August 2021 a 7-year-old Texas boy reported to his parents that he had been bitten by a bat. In the absence of bite marks, no rabies postexposure prophylaxis (PEP; rabies immunoglobulin and a vaccine series) was given. Two months later, he developed symptoms suggestive of rabies and a diagnosis was made; ultimately, he died 22 days after his symptoms began.
Initially the child had been seen at a healthcare facility for 2 days of right hand itchiness and right arm pain. He was discharged with symptomatic treatment, but the next day was seen at another facility with increased arm pain and a spreading rash. Acyclovir was given for suspected herpes zoster. Overnight, he developed delusions, nausea, vomiting, hypersalivation, and altered menta…