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Measuring antibody titres following rabies postexposure prophylaxis in immunosuppressed patients: a norm rather than the exception
  1. Ritin Mohindra1,
  2. Vikas Suri1,
  3. Debajyoti Chatterjee2 and
  4. Kirtan Rana3
  1. 1Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  3. 3Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Kirtan Rana; ranakirtan006{at}


We present a case of a 51-year-old immunosuppressed man with underlying chronic lymphoproliferative leukaemia (CLL), who presented to us in emergency with breathlessness, hydrophobia, anxiety and restlessness. He had a history of category 3 dog bite 2 months ago and had received a full course of rabies immunoglobulin and antirabies vaccine (ARV) as per the national schedule. As there were frank clinical reports of rabies, the patient was managed according to Milwaukee regimen. The patients died within a week of the appearance of symptoms. The brain autopsy revealed Negri bodies conforming the mortality due to rabies.

Immunosuppressed patients, like our patient who had CLL have low antibody formation after rabies prophylaxis. Antibody titres in immunosuppressed patients need to be measured after the 2–4 weeks of the last injection of ARV to decide whether a booster of ARV needs to be administered or not.

  • public health
  • emergency medicine

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  • Contributors RM managed the patient during his admission. VS critically reviewed the manuscript. DC did the histopathology of the specimen. KR wrote the manuscript and finalised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.