Diagnostic dilemma: Man caught rabies from organ transplant after donor was scratched by skunk
The patient: A man from Michigan
The symptoms: The man received a left kidney transplant at an Ohio hospital and about five weeks later began experiencing tremors, lower extremity weakness and urinary incontinence, as well as confusion.
The diagnosis: The man’s doctors suspected his signs and symptoms indicated a rabies infection, so they consulted the Ohio Department of Health and the U.S. Centers for Disease Control and Prevention (CDC) about the case. Various clinical samples from the patient were sent to the CDC for analysis and ultimately tested positive for rabies RNA, the genetic material of the virus, as well as antibody against the virus.
The treatment: Less than a week after his hospitalization, the patient died from his infection. Once rabies infection is established, there is no effective cure available. There are only approximately 30 reports of people surviving symptomatic rabies in the medical literature, and doctors cannot yet reliably reproduce this result. Rabies is therefore almost always fatal.
(People who suspect they have been exposed to rabies – such as after being bitten by an animal – may be treated with rabies antibodies or vaccines to prevent the virus from triggering an infection in the first place. This preventative treatment is very effective.)
What makes the case unique: This man’s rabies infection — the first reported in Michigan in about 15 years — was suspected of being potentially linked to his organ transplant, according to a report of the case. Investigators ruled out direct exposure to an animal as a source of infection.
After learning of the suspected infection, the CDC and its state and local partners launched an investigation into possible contamination of the donor kidney. The donor was from Idaho and investigators made contact with the donor’s family.
It turned out that “in late October 2024, a skunk approached the donor while he was holding a kitten in an outbuilding on his rural property,” the report states. “During an encounter that rendered the skunk unconscious, the donor suffered a scratch on his shin that was bleeding, but he did not believe he had been bitten. According to the family, the donor attributed the skunk’s behavior to predatory aggression toward the kitten.”
Five weeks after being scratched, the donor began experiencing symptoms suggestive of rabies, including confusion, difficulty swallowing, hallucinations and a stiff neck, a family member said. He then lost consciousness at home and did not wake up, although he was resuscitated and hospitalized. It was declared brain death and removed from life support five days later.
Notably, hospital staff members who treated the donor were unaware of the skunk’s scratch and attributed its symptoms to chronic illnesses and not rabies. That said, they took various clinical samples from the patient which the CDC then retroactively tested for the virus.
A biopsy of the donor’s right kidney came back positive, but there was no sample from the left kidney large enough to test. Still, it supports the idea that a donor kidney was likely the source of the Michigan man’s rage.
“This is the fourth case of transplant-transmitted rabies reported in the United States since 1978,” the case report notes. “However, the risk of transplant-borne infections, including rabies, is low.” In short, this chain of events is very unlikely and hospitals follow extensive protocols to guard against transplanting infected organs into patients.
For more intriguing medical cases, check out our Diagnostic Dilemma Archives.
This article is for informational purposes only and is not intended to offer medical advice.
