Case 5-2025: A 30-Year-Old Woman with Headache and Dysesthesia

A 30-year-old woman presented with an 8-day history of progressive dysesthesia, headache, and confusion following recent travel to Thailand, Japan, and Hawaii. Initial evaluations revealed peripheral eosinophilia and mild metabolic acidosis. Cerebrospinal fluid (CSF) analysis demonstrated eosinophilic meningitis, characterized by pleocytosis (694 white cells/μL, 8% eosinophils), elevated protein, and slightly decreased glucose levels. Given her travel history and clinical presentation, a presumptive diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis infection was made. Nucleic acid amplification testing (NAAT) of CSF confirmed the presence of A. cantonensis DNA. Treatment included a 14-day course of prednisone and albendazole, leading to symptom resolution. This case highlights the importance of considering parasitic infections in returning travelers with neurologic symptoms and eosinophilia, as well as the utility of molecular diagnostics for timely diagnosis.

A 30-year-old woman presented with an 8-day history of progressive dysesthesia, headache, and confusion following recent travel to Thailand, Japan, and Hawaii. Initial evaluations revealed peripheral eosinophilia and mild metabolic acidosis. Cerebrospinal fluid (CSF) analysis demonstrated eosinophilic meningitis, characterized by pleocytosis (694 white cells/μL, 8% eosinophils), elevated protein, and slightly decreased glucose levels. Given her travel history and clinical presentation, a presumptive diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis infection was made. Nucleic acid amplification testing (NAAT) of CSF confirmed the presence of A. cantonensis DNA. Treatment included a 14-day course of prednisone and albendazole, leading to symptom resolution. This case highlights the importance of considering parasitic infections in returning travelers with neurologic symptoms and eosinophilia, as well as the utility of molecular diagnostics for timely diagnosis.