Table 1 Summary of investigation findings of a 35-year-old male treated for probable rabies encephalomyelitis at the Central Regional Referral Hospital, Gelephu, Bhutan, 2023

Haemoglobin (g/L)

147

140–180

Mean corpuscular volume (fL)

82

81–99

White blood cell count (/μL)

8690

4000–10000

Neutrophil (%)

92

40–60

Platelet (/mL)

296

150–450

Urea (μmol/L)

3330 13,154

2498–7493

Creatinine (μmol/L)

106 168

53–115

Na/K (mEq/L)

130/3.8 165/5

133–146 / 3.8–5.4

Aspartate/Alanine transaminase (IU/L)

51/32

5–40/5–40

Bilirubin, total/direct (μmol/L)

41/10.3

1.7–20.5/ < 3.5

PT/INR

12.8/0.9

13.6– 7.5/0.8–1.2

Creatine phosphokinase (U/L)

1002

 < 171

Lactate dehydrogenase (U/L)

792

105–235

Dengue serology

Negative

Scrub typhus serology

Negative

Japanese encephalitis serology

Negative

Anti-HIV/Anti-HCV/HBsAg

Negative

Malaria parasite

Not seen

Blood culture

No growth

Urine culture

No growth

Tracheal aspirate culture

No growth

Electrocardiogram

Normal sinus rhythm

Cerebrospinal fluid (day 2)

WBC = 50 cells/mm³, Neutrophil 20%, lymphocyte 80%

Protein/albumin 1.5/1.5 μmol/L

No bacteria, no acid-fast bacilli

Culture = No growth

Rabies virus RT-PCR = Negative

Cerebrospinal fluid (day 18)

WBC = 250 cells/mm³, Neutrophil 15%, lymphocyte 85%

Protein/albumin 9.0/7.5 μmol/L

No bacteria, no acid-fast bacilli

Culture = No growth

Rapid fluorescent focus inhibition test

Cerebrospinal fluid < 16 (negative)

Serum = 2048 (positive)

Contrast-enhanced computed tomography brain (before admission)

No evidence of intracerebral space occupying lesion, infarct, intracerebral haemorrhage, no meningeal enhancement

Contrast-enhanced computed tomography brain (day 7)

Hypoattenuation in bilateral basal ganglia and thalamus (suggestive of viral encephalitis) and no evidence of cerebral oedema or brain herniation

Contrast-enhanced computed tomography brain (day 18)

Progressive global hypoxic ischemic encephalopathy