ANGIOSTRONGYLUS CANTONENSIS EOSINOPHILIC MENINGITIS MIMICKING TUBERCULOUS MENINGITIS CONFIRMED BY CEREBROSPINAL FLUID PCR: A DIAGNOSTIC CHALLENGE IN A TROPICAL COUNTRY
Main Article Content
Abstract
Background: Eosinophilic meningitis is a rare clinical syndrome most commonly caused by Angiostrongylus cantonensis, particularly in tropical regions. Because clinical manifestations and cerebrospinal fluid findings may overlap with tuberculous meningitis, misdiagnosis may occur, especially in tuberculosis-endemic countries. Clinical Case: We report a 45-year-old woman presenting with prolonged fever and headache. Cerebrospinal fluid analysis revealed marked pleocytosis, elevated protein levels, and reduced glucose concentration, with a small proportion of eosinophils. Initial microbiological investigations were negative, and the patient was empirically treated for tuberculous meningitis with adjunctive corticosteroids, resulting in transient clinical improvement. However, subsequent molecular testing of cerebrospinal fluid detected Angiostrongylus cantonensis DNA by polymerase chain reaction, establishing the diagnosis of eosinophilic meningitis. Anti-tuberculosis therapy was discontinued, and the patient recovered completely with supportive management. Conclusion: This case highlights the diagnostic challenge of eosinophilic meningitis mimicking tuberculous meningitis in tuberculosis-endemic settings. Molecular detection of Angiostrongylus cantonensis in cerebrospinal fluid plays a crucial role in establishing the correct diagnosis and preventing unnecessary anti-tuberculosis treatment.
Keywords
Eosinophilic meningitis, Angiostrongylus cantonensis, Tuberculous meningitis, Polymerase chain reaction
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
2. Melot B, Delvallez G, Gourinat AC, Molko N, Goarant C, Ducrot YM, et al. Eosinophilic meningitis in New Caledonia: The role of Angiostrongylus cantonensis?. PloS One. 2021. 16(8), e0254964, doi:10.1371/journal.pone.0254964.
3. Sohal RJ, Gilotra TS, Nguyen AD, Lui F. Angiostrongyliasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025. Available from: http://www.ncbi.nlm.nih.gov/books/NBK556067.
4. Phan HT, Tran KH, Nguyen HS. Eosinophilic Meningitis due to Angiostrongylus cantonensis in Children. Case Rep Neurol. 2021. 13(1), 184-9, doi: 10.1159/000512809.
5. Turck HC, Fox MT, Cowie RH. Paratenic hosts of Angiostrongylus cantonensis and their relation to human neuroangiostrongyliasis globally. One Health. 2022. 15, 100426, doi: 10.1016/j.onehlt.2022.100426.
6. Graeff-Teixeira C, da Silva ACA, Yoshimura K. Update on eosinophilic meningoencephalitis and its clinical relevance. Clin Microbiol Rev. 2009. 22(2), 322-48, doi: 10.1128/CMR.00044-08.
7. Liu J, Gao J, Zhou C. A case report on eosinophilic meningitis caused by Angiostrongylus cantonensis. Int J Med Sci. 2011. 8(6), 510-3, doi: 10.7150/ijms.8.510.
8. Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J, et al. Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. Clin Infect Dis Off Publ Infect Dis Soc Am. 2009, 48(3), 322-7, doi: 10.1086/595852.
9. Sawanyawisuth K, Takahashi K, Hoshuyama T, Sawanyawisuth K, Senthong V, Limpawattana P, et al. Clinical factors predictive of encephalitis caused by Angiostrongylus cantonensis. Am J Trop Med Hyg. 2009. 81(4), 698-701, doi: 10.4269/ajtmh.2009.09-0309.
10. Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y. Comparison of Prednisolone Plus Albendazole with Prednisolone Alone for Treatment of Patients with Eosinophilic Meningitis. Am J Trop Med Hyg. 2009. 81(3), 443-5, doi:10.4269/ajtmh.2009.81.443.