The diagnosis for mystery case #15

Great interest and many good comments on this case!

His diagnosis was:  Eosinophilic meningitis secondary to Angiostrongylus cantonensis infection. Angiostrongylus cantonensis is a parasitic nematode (roundworm) which causes angiostrongyliasis, the most common cause of eosinophilic meningitis in Southeast Asia and the Pacific Basin. The nematode commonly resides in the pulmonary arteries of rats, giving it the nickname rat lungworm.

Humans are incidental hosts of this roundworm, and may become infected through the ingestion of larvae in raw or undercooked seafood or other vectors, or from contact with contaminated water or vegetables. The larvae are then transported via the blood to the central nervous system, where they are the most common cause of this type of meningitis —  a serious condition that can lead to death or permanent brain and nerve damage, and that is characterized by a high eosinophil percentage.

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