Eosinophilic Meningitis in a Previously Healthy 13-year-old Child

Abstract

Keywords eosinophilic meningitis; Angiostrongylus cantonensis; rat lung wormA previously healthy 13-year-old male developed acute onset of a bi-temporal headache. The headache persisted, and two weeks later, he was diagnosed with sinusitis and was given amoxicillin. On illness day 17, he experienced worsening headache, slurred speech, transient left facial droop, right hand numbness, and dizziness. At a local emergency department (ED), magnetic resonance imaging (MRI) of the brain showed no significant abnormalities, though images were obscured by artifact from his orthodontic hardware. He was discharged without a specific diagnosis after his neurologic symptoms had resolved. On illness day 19, the patient had return of hand tingling and slurred speech and presented to the Children's Hospital Colorado ED. He was diagnosed with an atypical migraine and was treated with ketorolac, diphenhydramine, and prochlorperazine. His symptoms improved, and he was discharged.On illness day 20, the patient experienced severe right eye pain and recurrence of his headache. He returned to his local ED and was hospitalized after minimal clinical improvement with treatment for migraine. At that time, his Romberg sign was abnormal, he was ataxic, and he had diplopia. On illness day 22, he underwent a lumbar puncture (LP) because of concern of pseudotumor cerebri. The cerebral spinal fluid (CSF) showed white blood cell count (WBC) of 763/mm 3 (with a differential of 80% lymphocytes, 15% monocytes, and 5% eosinophils), red blood cell count (RBC) of 2/mm 3 , protein of 49 mg/dL, and glucose of 54 mg/dL. Intravenous acyclovir was started but was discontinued when polymerase chain reaction assay (PCR) of the CSF for herpes simplex virus returned negative. Bacterial and fungal cultures of the CSF were negative. He was discharged home after a three-day hospitalization.

Meningitis patients with Angiostrongylus cantonensis may present without eosinophilia in the cerebrospinal fluid in northern Vietnam

“…Trevor J. Slom et al reported that among 9 hospitalized patients with suspected EM caused by A. cantonensis, only 5 had CSF eosinophilia in the initial lumbar puncture [26], and 8 of the 9 patients finally exhibited CSF eosinophilia after hospitalization, although detailed changes in the patient blood eosinophil counts were not clearly reported. Furthermore, there has been a case report about a pediatric patient with A. cantonensis-induced EM within the USA [27]. His first CSF sample showed a WBC count of 763/mm 3 with 5% eosinophils, but later his CSF showed high eosinophilia, reaching 21% of the CSF WBCs.…”

“…Furthermore, there has been a case report about a pediatric patient with A . cantonensis -induced EM within the USA [ 27 ]. His first CSF sample showed a WBC count of 763/mm 3 with 5% eosinophils, but later his CSF showed high eosinophilia, reaching 21% of the CSF WBCs.…”

Angiostrongylus cantonensis Infection on Mayotte Island, Indian Ocean, 2007-2012

“…Since the first publication of the biological method in 2010 [ 17 ], it has been mainly used for the identification of the vector, especially in Hawaii, USA and Brazil [ 25 , 37 , 38 ]. Some publications reported the use of real time PCR for the diagnosis of human angiostrongyliasis, and not always successfully, in Hawaii and in Brazil [ 39 , 40 ]. We present here the most important positive case series, and demonstrate the great interest of this tool for the confirmatory diagnosis.…”

Real-Time Polymerase Chain Reaction Detection of Angiostrongylus cantonensis DNA in Cerebrospinal Fluid from Patients with Eosinophilic Meningitis

“…Clinical and epidemiological details have been presented elsewhere for six of the patients. [25][26][27][28][29] Five patients had knowingly ingested raw snails: four as part of exotic cuisine, one as a dare. Two patients were part of an outbreak in Jamaica where a Caesar salad was implicated as the source of infection.…”