Gnathostomiasis — Neuroimaging of Larval Migration

An 18-year-old man presented with symptoms that evolved over the course of three days and included fever, radicular back pain, vertigo, ataxia, headache, and left-sided hemiparesis. He reported that he had had skin swellings in a migratory pattern during the preceding month. His diet typically consisted of raw fish. A complete blood count showed 7100 white cells per cubic millimeter with 33 percent eosinophils. A computed tomographic scan of the brain showed diffuse swelling. A magnetic resonance image of the brain revealed multiple worm-like lesions in both hemispheres and the cerebellum (arrows, Panels A and B), which did not enhance . . .