Nguyen BT, Vo LT, Pham UH, Tran HN, Dang OHT, Nguyen DT, Tran TTH, To LT, Do VC, Nguyen TT. Clinical recovery of severe infantile Angiostrongylus cantonensis meningoencephalomyelitis treated with pulse methylprednisolone: A case report and review of literature. World J Clin Pediatr 2026; 15(3): 119602 [DOI: 10.5409/wjcp.119602]
Corresponding Author of This Article
Thanh Tat Nguyen, MD, PhD, Senior Researcher, Department of Infectious Diseases, Children’s Hospital 2, Ly Tu Trong, Ho Chi Minh City 700000, Viet Nam. thanhhonor@gmail.com
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Pediatrics
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case-report
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Nguyen BT, Vo LT, Pham UH, Tran HN, Dang OHT, Nguyen DT, Tran TTH, To LT, Do VC, Nguyen TT. Clinical recovery of severe infantile Angiostrongylus cantonensis meningoencephalomyelitis treated with pulse methylprednisolone: A case report and review of literature. World J Clin Pediatr 2026; 15(3): 119602 [DOI: 10.5409/wjcp.119602]
World J Clin Pediatr. Sep 9, 2026; 15(3): 119602 Published online Sep 9, 2026. doi: 10.5409/wjcp.119602
Clinical recovery of severe infantile Angiostrongylus cantonensis meningoencephalomyelitis treated with pulse methylprednisolone: A case report and review of literature
Bao Trung Nguyen, Luan Thanh Vo, Uyen Hai Pham, Hung Nam Tran, Oanh Hoang-Tran Dang, Dat Tat Nguyen, Tuong Trong-Hanh Tran, Lien Thi To, Viet Chau Do, Thanh Tat Nguyen
Bao Trung Nguyen, Luan Thanh Vo, Tuong Trong-Hanh Tran, Viet Chau Do, Thanh Tat Nguyen, Department of Infectious Diseases, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Uyen Hai Pham, Department of Neurology, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Hung Nam Tran, Department of Diagnostic Imaging, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Oanh Hoang-Tran Dang, Department of Nutrition, Children’s Hospital 2, Ho Chi Minh City 700000, Viet Nam
Dat Tat Nguyen, Department of Clinical Pharmacy, American International Hospital, Ho Chi Minh City 700000, Viet Nam
Lien Thi To, Faculty of Nursing, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam
Co-first authors: Bao Trung Nguyen and Luan Thanh Vo.
Author contributions: Nguyen BT and Vo LT were responsible for the clinical management of the patient and drafted the manuscript; Pham UH provided neurological consultation and follow-up assessments; Tran HN performed and interpreted the neuroimaging studies; Nguyen DT, Tran TTH, To LT, and Do VC contributed to data collection and literature review; Dang OHT coordinated nutritional support during hospitalization; Nguyen TT supervised the clinical care, critically revised the manuscript, and approved the final version; and all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Thanh Tat Nguyen, MD, PhD, Senior Researcher, Department of Infectious Diseases, Children’s Hospital 2, Ly Tu Trong, Ho Chi Minh City 700000, Viet Nam. thanhhonor@gmail.com
Received: February 2, 2026 Revised: March 6, 2026 Accepted: March 23, 2026 Published online: September 9, 2026 Processing time: 181 Days and 13.7 Hours
Abstract
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.
Core Tip: Angiostrongylus cantonensis meningoencephalomyelitis in infants is rare and often fatal. We report a case of a 10-month-old infant with deep coma, flaccid quadriplegia, and neurogenic shock who achieved near-complete neurological recovery. Early administration of pulse methylprednisolone (30 mg/kg/day for 5 days) combined with albendazole was associated with a favorable outcome. This case supports the early use of high-dose pulse corticosteroid therapy to attenuate inflammatory neurological injury and improve the prognosis in critically ill infants with severe eosinophilic meningoencephalomyelitis.
