患儿，男，5岁，黎族，三亚崖城人。于2020年3月1日出现发热、头痛、呕吐等症状，当地诊所以“胃肠型感冒”治疗，症状未见明显改善。3月8日起上述症状加重（剧烈头痛和呕吐），并伴神志淡漠、四肢乏力不能行走，带去当地某医院就诊，以“中枢神经系统感染”予抗感染等治疗，症状无改善迹象，并持续进展。于3月21日转入中南大学湘雅医学院附属海口医院，入院查体：体温38.5 ℃，神志模糊，呈易激惹状态，气促伴呼吸困难，脑膜刺激征阳性。行腰椎穿刺检查，压力为310 mmH₂O （1 mmH₂O = 133.32 Pa），脑脊液呈浑浊状。实验室检查：外周血嗜酸性粒细胞升高（1.87 × 10⁹/L）；脑脊液细胞总数1 080 × 10⁶/L，多核细胞占80%，潘氏试验阳性。初诊为“细菌性脑膜炎”，入院后予抗生素治疗6 d，疗效欠佳。患儿家长诉患儿有食生腌螺、虾、蟹的习惯。3月25日行影像学检测，胸部CT提示双肺多发炎性改变；头颅MRI示脑实质多发长条形强化灶。对脑脊液进行宏基因组二代测序，结果序列数为368，提示为广州管圆线虫感染。确诊该患儿为重型广州管圆线虫病。予阿苯达唑 20 mg/（kg·d）治疗10 d、地塞米松0.15 mg/（kg·d）静滴3 d，患儿头痛及发热症状缓解。出院2周后随访，患儿外周血嗜酸粒细胞为0.94 × 10⁹/L，头颅MRI示病灶消失、胸部CT示病灶缩小，ELISA检测广州管圆线虫血清抗体IgG阳性。出院8周后返院随访，患儿外周血嗜酸粒细胞为0.44 × 10⁹/L，ELISA检测广州管圆线虫血清抗体IgG阳性、脑脊液抗体IgG阴性，头颅MRI和胸部CT示病灶均消失。随访至2021年5月，患儿发育良好，无其他不适。

A 5-year-old boy, Liethnic group, was admitted to the Affiliated Haikou Hospital of Xiangya Medical College, Central South University on March 21, 2020 due to "a fever and headache for 3 weeks". The clinical manifestations were: recurrent fever (about 38.5 ℃), and severe headache with vomiting. The peripheral blood eosinophil count increased to 1.87 × 10⁹/L. Meningeal irritation was positive, accompanied by severe pneumonia, acute respiratory failure and other complications. A "bacterial meningitis" diagnosis was made intially and was treated with antibiotics for 6 days after admission. The patient’s parents claimed that the child had a history of eating snails, shrimps and crabs raw. Combined with the imaging results (head MRI showed multiple elongated foci of brain parenchyma, chest CT showed multiple inflammatory changes in both lungs) and the cerebrospinal fluid metagenomic next-generation sequencing results (sequence number 368 suggested Angiostrongylus cantonensis), the patient was diagnosed with severe angiostrongylus cantonensis. The patient was administrated with albendazole 20 mg/(kg·d) for 10 days and dexamethasone 0.15 mg/(kg·d) for 3 days. The headache and fever symptoms were relieved post the treatment. Two weeks after discharge, the eosinophil count in the peripheral blood decreased to 0.94 × 10⁹/L, the lesions on head MRI disappeared, the lesions on chest CT decreased, and the serum A. cantonensis specific IgG antibodies were positive by ELISA. Eight weeks after discharge, the eosinophil count in peripheral blood decreased to 0.44 × 10⁹/L, the lesions on head MRI and chest CT disappeared. The serum antibody IgG of A. cantonensis was positive by ELISA, while the IgG antibody in the cerebrospinal fluid was negative. The patient was followed up until May 2021, and developed well without other conditions.