Intestinal perforation secondary to abdominal angiostrongyliasis in an older infant with suspected extraintestinal involvement

Abstract Angiostrongyliasis is a parasitic disease caused by Angiostrongylus costaricensis (Latin America) and A. cantonensis (Asia/Pacific). Abdominal angiostrongyliasis often mimics appendicitis, challenging clinical diagnosis and requiring histopathological confirmation. We report a severely malnourished infant in Honduras presenting with 10 days of severe abdominal pain and vomiting, complicated by respiratory insufficiency and seizures. Brain CT revealed cortical atrophy, suggesting a chronic underlying neurologic condition. Laboratory tests showed leukocytosis, lymphocytosis, and massive eosinophilia. Exploratory laparotomy for suspected appendicitis identified an ileal perforation, requiring intestinal resection. Histopathology confirmed non-caseating granulomas containing A. costaricensis larvae within the mesenteric arteriovenous plexus, alongside scattered eggs. This is the first confirmed human case of abdominal angiostrongyliasis with suspected, unconfirmed extraintestinal involvement in the Olancho Department of Honduras. These findings emphasize the critical need for increased clinical awareness and public health measures against this overlooked parasitic infection. Statement of Significance This case documents the first confirmed Angiostrongylus costaricensis infection in Olancho, Honduras, presenting as intestinal perforation in an infant. For pathologists and trainees, this report underscores the diagnostic complexity of abdominal angiostrongyliasis, which frequently mimics appendicitis or Crohn’s disease. It illustrates the essential morphological features for diagnosis: intense eosinophilic vasculitis, granulomatous inflammation, and the specific identification of intra-arterial larvae and eggs. Additionally, the findings suggest rare disseminated disease in the context of severe malnutrition. This report highlights the critical need to maintain a high index of suspicion for parasitic etiologies in eosinophil-rich granulomatous lesions of the gastrointestinal tract, ensuring accurate diagnosis in regions where this neglected tropical disease is underrecognized.