A 30-Year-Old Woman with Headache and Dysesthesia

- This Case Records of the Massachusetts General Hospital article details the presentation and diagnostic evaluation of a healthy 30-year-old woman with subacute burning dysesthesia, progressing headache, and altered mental status following recent travel to Thailand, Japan, and Hawaii. Laboratory findings revealed eosinophilia in both blood and cerebrospinal fluid (CSF), raising suspicion for eosinophilic meningitis. Extensive differential diagnosis ultimately narrowed to infection with Angiostrongylus cantonensis, the rat lungworm, confirmed via nucleic acid amplification testing (NAAT) of the CSF. The article reviews global epidemiology, pathophysiology, and diagnostic workup of eosinophilic meningitis, emphasizing the relevance of travel history and the role of molecular testing. The patient improved with a combination of albendazole and corticosteroids, highlighting considerations for managing neuroangiostrongyliasis.

- This Case Records of the Massachusetts General Hospital article details the presentation and diagnostic evaluation of a healthy 30-year-old woman with subacute burning dysesthesia, progressing headache, and altered mental status following recent travel to Thailand, Japan, and Hawaii. Laboratory findings revealed eosinophilia in both blood and cerebrospinal fluid (CSF), raising suspicion for eosinophilic meningitis. Extensive differential diagnosis ultimately narrowed to infection with Angiostrongylus cantonensis, the rat lungworm, confirmed via nucleic acid amplification testing (NAAT) of the CSF. The article reviews global epidemiology, pathophysiology, and diagnostic workup of eosinophilic meningitis, emphasizing the relevance of travel history and the role of molecular testing. The patient improved with a combination of albendazole and corticosteroids, highlighting considerations for managing neuroangiostrongyliasis.