The article describes the case of an 8 year old girl from a rural county in California presented to a local emergency department (ED) with a 1-week history of progressive sore throat, difficulty in swallowing and weakness. Rabies was diagnosed based on the detection of the rabies virus, a compatible clinical syndrome in the patient and the lack of an alternative diagnosis. The patient was provided with advanced supportive care and treatment with therapeutic coma. INSETS: What is already known on this topic?;What is added by this report?;What are the implications for public health practice?.