OBJECTIVE To explore the causes for misdiagnosis of 1 rabies case as the mediastinal infection so as to raise the accuracy of clinical diagnosis and reduce the misdiagnosis and missed diagnosis rate of rabies.

METHOD The medical record of 1 case of rabies who was misdiagnosed as mediastinal infection and was treated in Hainan Hospital of PLA General Hospital was summarized and retrospectively analyzed.

RESULTS The case, male, 21 years old, presented the hospital with fever and sore throat for 3 days, expiratory dyspnea for 2 days and convulsions for 1 day. The result of clinical laboratory test showed that the white blood cell, neutrophils, procalcitonin, transaminase, lactic dehydrogenase and creatinine were elevated, indicating the disorder of coagulation function. The chest CT revealed subcutaneous and mediastinal emphesema in the neck, initially considering that a pharyngeal infection spreading to the mediastinum induced the mediastinal infection complicated with severe sepsis. Emergency surgery for neck debridement, drainage and tracheotomy were performed, no infection foci were found during the surgeries. The symptoms of the patient did not relieve after the symptomatic and supportive therapies including broad-spectrum antibiotics for anti-infection, continuous renal replacement therapy and fluid infusion were given to the patient, and the patient started to have disturbance of consciousness, convulsions, profuse sweating and significant salivation from the mouth and tracheostomy site. Upon further inquiry into the medical history, it was revealed that the patient had been bitten on the foot by a stray dog 3 years ago and was clinically diagnosed as rabies based on the medical history and clinical manifestations.

CONCLUSIONS Spontaneous mediastinal emphysema is an uncommon clinical manifestation for rabies and may also emerge during the early stage of rabies, which may lead to clinical misdiagnosis and improper treatment. It is necessary for the clinicians to raise the awareness of rabies, inquiry the medical history in detail, make meticulous physical examination and comprehensively analyze the clinical symptoms. The possibility of rabies should be taken into account for the newly hospitalized patients with mediastinal emphesema so as to avoid the misdiagnosis.