Background: Rabies is an almost invariably fatal viral encephalitis, extremely rare in Europe but still endemic in parts of Africa and Asia. Imported cases can present with atypical or misleading symptoms, especially when concurrent medical conditions divert diagnostic attention.

Case Report: We describe a 25-year-old man, born in Gambia and living in Northern Italy, admitted for a traumatic lower-limb amputation whose initial clinical picture was dominated by anxiety and dysphagia selectively for cold liquids. Hydrophobia, autonomic dysfunction, and encephalitic signs gradually developed. The suspicion of rabies was eventually raised by a nurse recalling hydrophobic behaviour from online clinical videos. Molecular testing confirmed rabies virus infection.

Conclusions: This case highlights the diagnostic pitfalls of imported rabies in non-endemic settings and the importance of maintaining clinical suspicion even when confounding factors such as trauma or psychiatric features predominate. Early recognition is essential for appropriate infection control precautions and post-exposure prophylaxis of contacts.