I read the recently published article in your journal by Peng et al.1 with great interest. The authors described an interesting case of acute disseminated encephalomyelitis following postexposure rabies prophylaxis. However, I have some comments on this article.
Comparison of rabies antibody responses of control group and this case was shown in Figure 2. According to this figure, antibody responses were compared beginning from d 14. However, corticosteroids were started to be used beginning from d 7. It is well known that protective antibody response to rabies vaccination begins at d 7.2 So, it could be more appropriate if comparison of the groups was made beginning from d 7.
Antibody response to rabies vaccination decreases with advanced age.3 Their case is a 73-y-old man. This point should be considered as a confounding factor which can inversely affect antibody response to rabies vaccination.
The authors concluded that steroids definitely had suppressed production of rabies virus neutralizing antibodies (RVNA). It is very difficult to make such a conclusion with only a single case. It can rather be concluded that steroids did not have a significant negative effect on the production of RVNA in this case.
References
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