Ocular Angiostrongylus cantonensis in a female vietnamese patient:: Case report

Background: Angiostrongylus cantonensis is largely responsible for human cases of eosinophilic meningitis and meningoencephalitis in the South Pacific and South-East Asia regions. Ocular manifestations of angiostrongylis are relatively rare. We report intraocular infestation and successful removal of a worm from the anterior chamber of a patient in Vietnam. Patient and methods: A 3-year old patient was referred to the eye hospital in Ho Chi Minh city, Vietnam, in December 2001 with clinical signs of acute iridocyclitis. The child and his family lived near the Mekong river. The medical history reported by the parents said that the girl had eaten raw snails two weeks before. After a week she developed high fever and for 3 days the right eye was red and painful. Her 8-year old brother was proven to have eosinophilic meningitis at the same time. Results: At first examination, biomicroscopically a 10 mm long and actively mobile, white, round worm was detected in the anterior chamber., Marked hyphema was also present. Routine blood examination showed pronouced eosinophilia. Preoperative treatment with systemic steroids and constriction of the pupil with 1% pilocarpine were initiated. After immobilising the worm by use of a viscoelastic agent in the anterior chamber, it was successfully removed via a clear-corneal incision. The worm was identified as a male Angiostrongylus cantonensis. Postoperative ophthalmoscopic examination showed an inactive organised cyst at the optic disc border. The child was discharged from the hospital after a week with a visual acuity of 0.6. Conclusion: Parasitic infestation is a major health problem in tropical countries. This is the first description of ocular infestation of Angiostrongylus cantonensis in children. No antiparasitic drugs are yet available to treat ocular involvement, thus therapeutic success depends upon early and complete surgical removal of the parasite.