2023-06-24 16:14:10
Today in weird patientthe challenge of a teenager who turns very badly.
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The challenges adolescents set themselves to test their courage sometimes have dramatic consequences. In Australia, a teenager accepts an unsavory challenge from his friends: to eat two slugs they found in his garden in Sydney. Chick! The young man runs but will regret it bitterly.
A few days later, he starts to feel bad. He contracts a violent gastro that lasts a week but eventually recovers. Three weeks later, he feels nauseous, vomits repeatedly, and suffers from stiff neck and intolerance to bright lights. With his parents, he goes to the hospital to find out what is wrong. On auscultation, doctors identify low-grade fever and signs of meningitis, but her brain scan shows no problems.
On the other hand, his blood test is more worrying. He has an eosinophilic granulocyte count well above normal; monocytes are also present in large quantities in his cerebrospinal fluid. Eosinophilia is usually associated with a parasitic infection or an allergy. Doctors do a test for two species of parasitic worms common in Australia: Strongyloidess and Angiostrongylus. The results are negative. After 12 days in the hospital he returns home; his meningitis considered cured.
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Except that his condition suddenly worsens five days later, forcing his family to return to the hospital. He was admitted in a worrying state: irritable, drowsy, a papilledema of the eye which testifies to an excessive pressure in the skull and numb hands. His blood tests reveal eosinophilia three times more severe than when he was first hospitalized. This time, the brain scan shows multiple lesions in the white matter. The doctors question the young patient who ends up admitting that he ate two slugs five weeks before. The presence of the parasite is finally confirmed.
The two molluscs were two leopard slugs (the biggest slug)one of the intermediate hosts of Angiostrongylus cantonensis, a parasitic worm several centimeters long that normally infects the lungs of rats. Humans are accidental hosts of the worm, which becomes contaminated by eating raw or undercooked molluscs, or vegetables contaminated by larvae. These reach the adult stage following two to three weeks and cause what doctors call eosinophilic meningoencephalitis.
Sometimes fatal cases
The teenager stayed 17 days in the hospital and took more than five months to recover from the infection before returning to a normal daily life. This case described in 2003 is the first report of acquired human angiostrongyliasis, but not the last.
In 2010, a young Australian did the same challenge: eat slugs. The molluscs were also contaminated with Angiostrongylus which plunged him into a coma for 420 days and left him paralyzed from head to neck for eight years. He finally died in 2018.
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