A woman’s recent vacation to Thailand, Japan, and Hawaii took a terrifying turn when she began experiencing burning pain in her legs, which doctors later linked to brain worms. Initially attributing her symptoms to jet lag and fatigue, the 30-year-old woman from coastal New England sought medical attention as the burning sensation spread from her feet to her legs, worsening even with light touch.
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After undergoing tests at a medical facility that yielded normal results, except for a high count of white blood cells, the woman was advised to follow up with her primary care doctor. However, her condition deteriorated as the burning sensation extended to her body and arm, accompanied by a persistent headache that did not respond to over-the-counter medication. Concerned by her confusion and disorientation, her roommate rushed her to Massachusetts General Hospital for further evaluation.
At Mass General, the woman was diagnosed with a human infection caused by larvae of the rat lungworm, leading to her symptoms of burning legs and cognitive impairment. Dr. Joseph Zunt, a neurologist and infectious disease specialist involved in her care, explored the possibility of eosinophilic meningitis from Angiostrongylus cantonensis, considering her activities during the vacation, where she frequently consumed sushi and salad and swam in the ocean in Hawaii.
The rat lungworm parasite, Angiostrongylus cantonensis, is endemic in Hawaii and can be contracted through various sources, including ingestion of raw or undercooked infected snails or slugs, contaminated fruits or vegetables, or paratenic hosts like land crabs. The complex life cycle involves rats passing the infection through their feces, which snails and slugs ingest, eventually contaminating other sources. Treatment for the woman included prednisone to suppress her immune system and anti-parasitic medication, leading to her discharge after six days of care.
The case study of this woman’s experience with brain worms highlights the importance of considering unusual causes for neurological symptoms, especially after travels to regions where such infections are prevalent. This rare instance serves as a reminder of the potential risks associated with consuming undercooked or contaminated food while on vacation in tropical areas like Hawaii.
This incident underscores the significance of thorough medical investigations and collaboration between specialists to determine accurate diagnoses and provide prompt treatment for unusual infections. The woman’s swift recovery after targeted therapy demonstrates the effectiveness of tailored interventions in managing parasitic illnesses acquired during travel. Healthcare providers continue to emphasize the importance of awareness and preventive measures to minimise the risk of unusual infections in travellers returning from tropical destinations.