Clinical recovery of severe infantile Angiostrongylus cantonensis meningoencephalomyelitis treated with pulse methylprednisolone: A case report and review of literature

Table 1 Clinical and laboratory characteristics from disease onset to discharge

Phases	Clinical status	Laboratory findings	Imaging	Interventions
At provincial hospital (day 1)	Continuous high fever, severe vomiting, anorexia, excessive crying, acute diarrhea (4-5/day), scattered urticarial rash	Blood: WBC 23.77 (× 109/L); Eos 2.61 (× 109/L); CRP 35 mg/L; CSF: 89 cells/μL (lymphocytic predominance), Pandy (+)	Not performed	Cefotaxime
At emergency department admission (day 3)	Persistent fever, lethargy, bulging fontanelle, urticarial rash, paraparesis (muscle tones of lower limbs 3/5 and upper limbs 5/5)	Blood: WBC 17 (× 109/L); Eosin 2.54 (× 109/L); CRP 65 mg/L; Na+ 130 mmol/L; routine cultures of blood and CSF: Negative; repeated CSF: 142 cells/μL; Eos 32.4%; protein 0.47 g/L	Brain CT-scan: No evidence of acute hemorrhage, mass effect, or significant ventriculomegaly	Cefotaxime + vancomycin
On PICU admission (day 6)	High fever 40 °C, coma, respiratory failure, shock status (HR 175 bpm; BP 70/30 mmHg), flaccid quadriplegia, muscle tones 0/5, urinary retention, mild edema	WBC 21.87 (× 109/L), eosin 3.2 (× 109/L) Na+ 125 mmol/L, K+ 2.2 mmol/L; PCR-CSF: Positive for A. cantonensis; (Ct 30.41; approximately 1.55 × 105 copies); repeated CSF: 266 cells/μL; Eos 22%; protein 2.3 g/L	Brain MRI: Diffuse; white/gray matter; lesions, ventricular; dilation; spine MRI: Signal; abnormalities C3-C6, lumbosacral meningeal; enhancement	Mechanical ventilation; fluid resuscitation and vasopressor use; cerebral anti-edema with 3% NaCl; methylprednisolone (30 mg/kg/day); albendazole (15 mg/kg/day)
At PICU discharge (day 28)	Afebrile, alert, communicative, respiratory and urinary continence improvement, muscle tones: Upper limbs 2/5, and lower limbs 3/5; hospital acquired pneumonia	WBC improved; immunology: Oligoclonal band (+) type 2; PCR of blood and sputum samples revealed; Acinetobacter and Pseudomonas spp.; CSF: 125 cells/μL		Extubation, intensive physical therapy, tapered oral prednisolone, and intravenous antibiotics for hospital acquired pneumonia
At hospital discharge (day 49)	Fully alert, independent feeding	Normalized full blood counts and CSF findings	Brain MRI: Thin right subdural hygroma, ventriculomegaly	Discharged, continue home physical therapy

HR: Heart rate; BP: Blood pressure; WBC: White blood cell; G/L: Giga per liter (× 10⁹/L); Eos: Eosinophils; CRP: C-reactive protein; CSF: Cerebrospinal fluid; CT: Computed tomography; MRI: Magnetic resonance imaging; EEG: Electroencephalogram; PCR: Polymerase chain reaction.