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Case Report: Angiostrongylus cantonensis Infection Presenting as Small Fiber Neuropathy

Johnnie YatesKaiser Permanente, Honolulu, Hawai’i;

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Todd DevereKaiser Permanente, Honolulu, Hawai’i;

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Sharin Sakurai-BurtonKaiser Permanente, Honolulu, Hawai’i;

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Brock SantiUniversity of Hawai’i John A. Burns School of Medicine, Honolulu, Hawai’i;

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Cali McAllisterUniversity of Hawai’i John A. Burns School of Medicine, Honolulu, Hawai’i;

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Kiana FrankUniversity of Hawai’i Pacific Biosciences Research Center, Honolulu, Hawai’i

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ABSTRACT.

Angiostrongylus cantonensis is an emerging parasite that is the most common cause of eosinophilic meningitis worldwide. Human infection typically presents with headache, neck stiffness, and paresthesia. We report a case of a woman with PCR positive A. cantonensis infection who presented with symptoms of small fiber neuropathy (SFN) but no headache. SFN was confirmed by skin biopsy. After failing standard medications for neuropathy, she was treated with intravenous lidocaine with considerable improvement. However, she required medications for 1 year to treat her chronic neuropathy. Infection by A. cantonensis should be added to the list of causes of SFN, and its potential to cause chronic sequelae should be appreciated.

Author Notes

Address correspondence to Johnnie Yates, Kaiser Permanente, 3288 Moanalua Rd., Honolulu, HI 96819. E-mail: johnnie.a.yates@kp.org

Authors’ addresses: Johnnie Yates, Todd Devere, and Sharin Sakurai-Burton, Kaiser Permanente, Honolulu, HI, E-mail: johnnie.a.yates@kp.org. Brock Santi and Cali McAllister, University of Hawai’i John A. Burns School of Medicine, Honolulu, HI. University of Hawai’i Pacific Biosciences Research Center, Honolulu, HI.

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