Neuroangiostrongyliasis after consumption of the monitor lizard

A 26-year-old man from northern Kerala, India, with no significant premorbid illness, presented with severe headache, nausea, vomiting, and generalized myalgia of one week’s duration. He described marked disproportional discomfort and pain when clothing touched his skin, particularly over the trunk and proximal limbs, leading him to avoid wearing normal garments. Approximately two weeks prior to symptom onset, the patient had consumed the raw tongue and gallbladder of a monitor lizard, a dietary practice undertaken during a local hunting ritual. On examination, he was afebrile and haemodynamically stable. Meningeal signs were present, but cranial nerve function and higher mental status were intact. Sensory testing elicited exaggerated pain responses to light touch over the trunk and thighs. Laboratory investigations showed peripheral blood eosinophilia (Absolute Eosinophil count-1200/mcL). Cerebrospinal fluid (CSF) analysis demonstrated pleocytosis with eosinophils (250 cells, 11% Eosinophils), elevated protein (192 mg/dl), and normal glucose. Magnetic resonance imaging of the brain showed no focal parenchymal lesions. Polymerase chain reaction testing of CSF detected Angiostrongylus cantonensis, confirming the diagnosis of neuroangiostrongyliasis. The patient was treated with systemic corticosteroids, which were gradually tapered. Headache and meningeal symptoms improved rapidly. At one-month follow-up, the patient had significant resolution of allodynia and was able to tolerate normal clothing without discomfort.