A case of eosinophilic meningitis in Germany

JO N 2 84 6 philic cells, a slightly elevated protein level (55 mg/dl) and bloodCSF barrier dysfunction. The immunoblot for Angiostrongylus cantonensis performed at the Department of Helminthology at Mahidol University in Bangkok was positive (Fig. 1) as well as the ELISA for toxocariasis at the Department of Infectious Diseases and Tropical Medicine at LudwigMaximilians-Universitat in Munich. Infection with Borrelia burgdorferi, Treponema pallidum, human immunodeficiency virus, other helminths and fungi and Plasmodium falciparum were excluded by serological tests and blood film microscopy. No findings supported the diagnosis of vasculitis or indicated haematological malignancy. After lack of spontaneous improvement over months we started oral treatment with albendazole 400 mg, twice daily and prednisolone 60 mg, one dose per day. One week with treatment did not improve the patient. Then, prednisolone was tapered and the symptoms rapidly disappeared and have not reappeared up to now. Albendazole was continued for another two weeks. Lumbar puncture following treatment did not show any pathological findings. Eosinophilic meningitis is a rare syndrome, which should always lead to suspicion of parasites. According to the laboratory findings two worms, Toxocara and Angiostrongylus cantonensis, had to be considered as possible causes. Toxocariasis, generally acquired by close contact with dogs or cats, is found worldwide, partly with high seroprevalence. As the patient had no close contact to pets and no central nervous system involvement (isolated benign meningitis is very rare [1]), cerebral toxocariasis seemed to be very unlikely. Crossreactivity of toxocariasis ELISA with Angiostrongylus cantonensis was supposed. Angiostrongyliasis, Stefanie Kirsch Paron Dekumyoy Thomas Loescher Roman L. Haberl