title: Fatal parasitic meningoencephalomyelitis caused by Halicephalobus deletrix : a case report and review of the literature.
abstract: Infection with the saprophagous nematode Halicephalobus species is uncommon but has been reported in horses worldwide. Only 3 human cases have been previously described, all of which have been fatal. We report a fourth fatal case, which occurred in a 39-year-old woman who presented with meningeal signs, altered mental status, and a prodromal pruritic rash. Diagnostic evaluation included an open brain biopsy, which was diagnosed as granulomatous vasculitis. The patient subsequently died after a course of steroids and cyclophosphamide. At autopsy, a robust perivascular mixed inflammatory infiltration of the brain parenchyma, meninges, and ventricular system was present with larval forms and mature nematodes morphologically consistent with Halicephalobus deletrix . Although extremely rare, this organism needs to be considered in the differential diagnosis of human helminthic infection of the central nervous system.
authors.affiliation: Department of Pathology and Laboratory Medicine, Cleveland Clinic, Ohio 44195, USA. ondrejs@ccf.org
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Ondrejka
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
authors.forename: Keith K
authors.initials: KK
authors.lastname: Lai
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
mesh_terms: D000328:Adult; D000818:Animals; D001921:Brain / Q000469:parasitology / Q000473:pathology; D003937:Diagnosis, Differential; D004679:Encephalomyelitis / Q000175:diagnosis / Q000469:parasitology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008590:Meningoencephalitis / Q000175:diagnosis / Q000469:parasitology*; D017168:Rhabditida / Q000302:isolation & purification / Q000472:pathogenicity; D017196:Rhabditida Infections / Q000175:diagnosis / Q000469:parasitology*