Abstract:

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.

Key words: Angiostrongyliasis cantonensis, Severe eosinophilic encephalitis, Albendazole, Metagenomic next-generation sequencing