A woman who had just returned from a dream vacation ended up with a nightmare condition.
The New England native, 30, had just spent three weeks traveling around Thailand, Japan and Hawaii, where she swam in the ocean and frequently dined on salads and sushi.
When she returned home, she noticed that she felt a little fatigued, which she initially simply blamed on jet lag.
But then her symptoms got worse, and she began experiencing a burning sensation in her feet that traveled up through her legs.
She was hospitalized, but her test results seemed to indicate that she was fine — until she had to go back to the emergency room because the burning sensation had migrated to her arms and was now accompanied by a severe headache.
She was ultimately treated at Massachusetts General Hospital by Dr. Carlos A. Portales Castillo and became a case study in The New England Journal of Medicine.
According to Castillo, the woman’s roommate rushed her to the hospital once more after “she awoke, she thought she needed to pack for vacation and was not redirectable,” continuing to be disoriented for several hours, People reported.
The prognosis? Angiostrongyliasis — a parasitic infection caused by Angiostrongylus species, most commonly Angiostrongylus cantonensis, which is also known as “rat lungworm.”
While rats are the primary hosts of this infection, snails and slugs can act as intermediate hosts, and humans can become infected by consuming them raw or undercooked.
Dr. Joseph Zunt, a neurologist who specializes in infectious diseases, came to this diagnosis after doctors performed a lumbar puncture, also known as a spinal fluid test, and discovered she had eosinophilic meningitis — inflammation of the membranes around the brain and spinal cord.
He also connected the dots after finding out more about her behavior in Hawaii, where the infection is a known issue.
Most of the cases in Hawaii have been on the Big Island, though it’s popped up in the other major islands as well. Though there haven’t been any documented cases yet in 2025, there were eight in 2024 — seven residents and one visitor.
Infection can occur from eating raw or undercooked infected snails or slugs, fruits or veggies that have been contaminated, or an land crabs, freshwater prawns, frogs that have themselves eaten an infected snail. This patient most likely became sick while eating food that was contaminated with snail or slug slime.
Symptoms of rat lungworm often start with nausea, vomiting, and stomach pain, starting hours or days after eating contaminated food, according to Hawaii’s Disease Outbreak Control Division.
Headache, fever, muscle pain, fatigue, insominia, and neurologic symptoms can develop, as can neck stiffness and pain, tingling or burning of the skin, double vision, bowel or bladder difficulties, and seizures.
Children may experience more fever, irritability, somnolence, lethargy, gastrointestinal symptoms, muscle twitching, convulsions, and extremity weakness. In addition, individuals may experience a few days to weeks of no symptoms followed by neurologic symptoms.
Because cases are often misdiagnosed or underreported, it’s difficult to determine precisely how frequently people contract this illness. However, Hawaii typically reports 10-12 cases per year, and it has occurred in other tropical regions, such as Florida and Texas.
There is no specific cure for this infection, so treatment usually focuses on pain management. In this patient’s case, she was treated with the anti-inflammatory steroid prednisone and sent home from the hospital after six days.
In January, a disturbing X-ray of a human body riddled with worms went viral after the patient contracted cysticercosis — which begins with eating undercooked pig but is passed through fecal matter.
Just another good reminder to always wash your hands!
