Rabies post-exposure prophylaxis after previous immediate hypersensitivity: A case report
When managing PEP in a patient with a history of vaccine-related hypersensitivity, anticipate the need for advanced life support equipment and adjuncts like epinephrine, even if the reaction seems mild. Always confirm the patient's immunization status and consider the risk stratification of the exposure, as the need for prophylaxis remains paramount despite prior adverse events. Be prepared to manage anaphylaxis while simultaneously administering the vaccine series.
This case report details the management of rabies post-exposure prophylaxis (PEP) in a young woman with a high-risk exposure following a stray-cat bite. The critical aspect of this case is that the patient had a history of immediate hypersensitivity reactions, specifically tongue swelling and generalized urticaria, after receiving her initial rabies vaccine dose in 2022, leading to an incomplete immunization series. Given the high-risk nature of the current exposure and her incomplete vaccination status, the administration of the required PEP had to occur in a resuscitation setting, necessitating the use of intramuscular epinephrine and advanced airway support. This highlights the practical challenges of managing vaccine administration in patients with known, but perhaps poorly characterized, vaccine-related hypersensitivity.