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A Difficult Case
… At Least in Scotland
  1. P. Shah*,
  2. G. Stewart*,
  3. A.R. Fooks†,
  4. D Pounder‡,
  5. P. McIntyre§,
  6. D. Nathwani,
  7. K. White*
  1. *Departments of Neurology,
  2. §Virology and
  3. Infectious Diseases, Ninewells Hospital and Medical School, Dundee;
  4. †Rabies Research and Diagnostic group, Veterinary Laboratories Agency (Weybridge) WHO Collaborating Centre for Characterisation of Rabies and Rabies-Related viruses, Surrey;
  5. ‡Department of Forensic Medicine, University of Dundee, UK., E-mail: kathleen.white{at}tuht.scot.nhs.uk

Abstract

THE STORY

A right-handed conservationist in his fifties, who was also an artist and licensed bat handler, was admitted to hospital with a history of acute painless haematemesis. He also complained of severe pain in his left arm and shoulder over the preceding 7 days for which he had been taking ibuprofen without much benefit. Past medical history included pulmonary tuberculosis in childhood. He was otherwise well. There was no family history of note.

He had not been abroad in the previous 7 years, and had been resident in Angus, Scotland, for 3 years, working with Scottish National Heritage. He was able to give a history of bat contact, indeed he had been bitten by a Daubenton’s bat (Fig. 1) on his left hand 4 months prior to admission. He had never in the past received any anti-rabies vaccine nor had he received any post-exposure anti-rabies prophylaxis.

ON EXAMINATION

He

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