107 Intestinal Angiostrongyliasis caused by Angiostrongylus costaricensis, rare infectious disease in United States

Introduction/Objective Angiostrongylus costaricensis is a nematode causing abdominal/intestinal Angiostrongyliasis. After the first description of this entity in 1971 in Costa Rica, it is found to be prevalent in Latin American countries and Caribbean. Although the organism is found in some animals in southern parts of United States, sporadic cases diagnosed are exclusively travel associated. Here we are presenting a rare case of this entity. As diagnosis still remains challenging due to unavailability of noninvasive laboratory testing till date. Methods/Case Report A 29-year-old female presented with Right lower quadrant abdominal (RLQ) pain and weight loss with no other significant medical or surgical history. Her medical history was negative for symptoms like - fever, chills, night sweats, nausea, vomiting or diarrhea. Patient reported recent travel to Costa Rica. Computed tomography scan of abdomen and pelvis revealed RLQ cecal/ascending colon mass, averaging 6 cm in size. The final interpretation was malignant neoplasm of uncertain behavior. Patient then underwent right hemicolectomy. Gross examination revealed induration and ulceration on ileocecal valve and cecum. Histologic sections revealed cecum with marked ischemic changes with associated eosinophilic granulomatous inflammation and intravascular nematode organisms. Taken together the clinical presentation, travel history and histopathological findings the diagnosis was consistent with abdominal Angiostrongyliasis. Results N/A Conclusion By presenting this case, we want to create awareness of this infectious disease among pathologists here in United States, as although it is rarely encountered in clinical practice the gold standard for diagnosis is histopathology after surgical resection. Having a travel history to the endemic area is crucial for a correct diagnosis. More studies are needed to develop noninvasive techniques using molecular and immunological tools to diagnose and treat this entity more effectively in future.