A Thai housewife had a fatal illness characterized initially by abdominal pain and an intense peripheral eosinophilia and later by signs and symptoms referable to the central nervous system. An eosinophilic pleocytosis was also observed. At autopsy, hemorrhagic necrotic tracts were observed in the brain and spinal cord, and an adult male nematode, Gnathostoma spinigerum, was recovered from the cervical or upper thoracic region of the cord. The patient was known to have been fond of foods that often harbor the infective larvae of this parasite. Although most reported cases of gnathostomiasis in man have involved only relatively superficial tissues of the body, and the present case is the first known fatality caused by this parasite, it is suggested that many severe and even fatal cases are unrecognized because of the difficulty of establishing the diagnosis.
Department of Neurology and Neurosurgery, Somdet Chaopraya Hospital, Thonburi, Thailand.
Pacific Research Section, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, Honolulu, Hawaii. Address requests for reprints to P. O. Box 1680, Honolulu, Hawaii 96806 (Dr. Rosen).