Neuroangiostrongyliasis (Rat Lungworm Disease) in a Philippine Tertiary Center: Clinical experience, diagnostic challenges and review of literature

<i>Angiostrongylus cantonensis</i> is the leading parasitic cause of eosinophilic meningitis but there have been no cases of human infection reported from the Philippines. We report a 25-year-old female, with a dietary preference for raw lettuce, who presented with a two-week history of low-grade fever, malaise, progressive holocranial headache, and myalgia. She had Grade 2 papilledema, nuchal catch, and peripheral eosinophilia. Lumbar puncture eventually revealed eosinophilic meningitis. Extensive diagnostics were completed to exclude all potential infectious, hematologic, and rheumatologic causes of central and peripheral eosinophilia eventually leading to the conclusion of Probable Neuroangiostrongyliasis. She was managed conservatively until discharge and remained headache-free one year later. This case highlights important challenges in the diagnosis and management of this extremely rare zoonosis in the Philippine setting and demonstrates the need for increased public and medical awareness regarding this condition.