https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/228 Mon, 05 Jun 2017 09:20:32 +0000 A case of post-vaccination myelitis following administration of chick embryo cell rabies vaccine in a 20 year-old young lady is described. The case presented with paraplegia five days after receiving the third dose (on 12th day) of the vaccine for rabies. Myelitis was confirmed by signal changes on magnetic resonance imaging (MRI). She improved considerably on steroids treatment. This is the first case of myelitis following rabies chick embryo cell vaccination in Bangladesh. Address for Correspondence: Dr. Shapur Ikhtaire, Medical Officer, Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU). Email: ikhtaireshapur@yahoo.com   There have been reports of neuroparalytic complications following nerve tissue anti-rabies vaccination.1,2 Also, a case of myelitis occurring after administration of rabies duck embryo vaccine has been reported.3 Here, a case of myelitis in a young Bangladeshi woman following rabies chick embryo cell vaccination is described. Case presentation Treatment was started with high dose intravenous steroids consisting of 1gm methyl prednisolone daily for 3 days. This was followed by oral prednisolone at a dose of 40mg daily for 1 month with gradual tapering. Retention was initially relieved by urinary catheterization. Urinary catheter was removed on the second day of therapy. Patient was able to pass stool after another two days. Although weakness of the lower limbs improved after a week, jerks still remained brisk and the planter reflexes remained extensor. The remaining doses of rabies vaccine were stopped and vaccination was discontinued. The patient was discharged with oral prednisolone. A diagnosis of post-rabies vaccine myelitis was made based on the history of recent vaccination, upper motor neuron signs and high signal intensity on MRI. Discussion There have been reports of myelitis occuring after rabies duck embryo vaccine. In one report, a 41-year-old farmer developed myelitis 14 days after the first inoculation of rabies duck embryo vaccine.3 Four cases of transverse myelitis were reported among 424,000 people who received duck embryo rabies vaccine between 1958 and 1971.4     There are many cases of myelitis in our country. A precipitating factor is not always sought. Rabies vaccination may be an important cause and should be searched for in the history of patients with myelitis. People who are vaccinated with purified chick embryo rabies vaccine should be followed to see if they develop signs of spinal pathology. A thorough search of the literature indicates that our case is the first case of myelitis following rabies chick embryo cell vaccination in Bangladesh. References 2.   Ahasan HA, Chowdhury MA, Azhar MA, Rafiqueuddin AK. Neuroparalytic complications after anti-rabies vaccine (inactivated nerve tissue vaccine). Tropical  Doctor 1995; 25: 94. 4.   Rubin RH, Hattwick MAW, Jones S, Gregg MB, Schwartz V D. Adverse reactions to duck embryo rabies vaccine. Journal of the American Medical Association 1973; 78: 643-649. 5.    Bir LS, Eþmeli FO, Cenikli U, Erdoðan C, Deðirmenci E. Acute transverse myelitis at the conus medullaris level after rabies vaccination in a patient with Behçet’s disease. Journal of Spinal Cord Medicine 2007; 30(3): 294–296. 2026 Ibrahim Medical College. All rights reserved.