Clinical recovery of severe infantile Angiostrongylus cantonensis meningoencephalomyelitis treated with pulse methylprednisolone: A case report and review of literature.

BACKGROUND: Angiostrongylus cantonensis (A. cantonensis) is the leading cause of eosinophilic meningitis worldwide. Although infection is often self-limiting in adults, infants may develop severe meningoencephalomyelitis, associated with high morbidity and mortality. The optimal corticosteroid regimen for infants with severe disease and extensive central nervous system involvement remains unclear, and standard-dose corticosteroid therapy may be ineffective in acute fulminant cases.

CASE SUMMARY: A 10-month-old female infant was admitted with fever and vomiting, followed by rapid progression to deep coma, generalized seizures, flaccid quadriplegia, respiratory failure requiring mechanical ventilation, and neurogenic shock necessitating vasopressor support. Eosinophilic meningomyelitis was confirmed by marked eosinophilia in the cerebrospinal fluid (CSF) (42%). The CSF analysis with polymerase chain reaction was positive for A. cantonensis (Ct value 30.41; approximately 1.55 × 105 copies). Magnetic resonance imaging revealed diffuse bilateral cerebral lesions with longitudinal cervical myelitis (C3 to C6). The patient was treated with high-dose methylprednisolone (30 mg/kg/day for 5 days), combined with albendazole (15 mg/kg/day for 21 days), which resulted in substantial neurological improvement. The patient was weaned off mechanical ventilation on day 16 and discharged on day 49 with mild residual weakness in the lower extremities. At five months post-discharge, the neurodevelopmental assessment was largely age-appropriate, with marked resolution of the motor and cognitive functions.

CONCLUSION: Pulse methylprednisolone is more effective than standard-dose corticosteroids for treating severe infantile A. cantonensis meningoencephalomyelitis with extensive, life-threatening neurological involvement.