A 30-Year-Old Woman with Headache and Dysesthesia

A 30-year-old woman presented with progressive dysesthesia, worsening headache, and confusion following recent travel to Thailand, Japan, and Hawaii. Initially experiencing burning sensations in her feet, the symptoms spread to her legs, trunk, and arms, becoming more intense with light touch. After initial evaluations ruled out common infectious causes, further laboratory tests revealed eosinophilia and metabolic acidosis.

A lumbar puncture showed elevated cerebrospinal fluid (CSF) white-cell count, with eosinophilic predominance and low glucose levels, leading to the diagnosis of eosinophilic meningitis. Given her travel history and dietary exposures—including consuming sushi and salads in Hawaii the most likely causative agent was identified as Angiostrongylus cantonensis (rat lungworm).

Treatment included glucocorticoids and albendazole, with gradual symptom improvement. CSF nucleic acid amplification testing (NAAT) confirmed Angiostrongylus cantonensis DNA, solidifying the diagnosis. The case underscores the importance of recognizing travel-related parasitic infections, particularly in patients with neurologic symptoms and eosinophilia.

A 30-year-old woman presented with progressive dysesthesia, worsening headache, and confusion following recent travel to Thailand, Japan, and Hawaii. Initially experiencing burning sensations in her feet, the symptoms spread to her legs, trunk, and arms, becoming more intense with light touch. After initial evaluations ruled out common infectious causes, further laboratory tests revealed eosinophilia and metabolic acidosis.

A lumbar puncture showed elevated cerebrospinal fluid (CSF) white-cell count, with eosinophilic predominance and low glucose levels, leading to the diagnosis of eosinophilic meningitis. Given her travel history and dietary exposures—including consuming sushi and salads in Hawaii the most likely causative agent was identified as Angiostrongylus cantonensis (rat lungworm).

Treatment included glucocorticoids and albendazole, with gradual symptom improvement. CSF nucleic acid amplification testing (NAAT) confirmed Angiostrongylus cantonensis DNA, solidifying the diagnosis. The case underscores the importance of recognizing travel-related parasitic infections, particularly in patients with neurologic symptoms and eosinophilia.