Massachusetts General Hospital

Man’s health crashes after getting donated kidney—it was riddled with worms

health, infection, Massachusetts General Hospital, NEJM, parasitic worms, strongyloides, Strongyloides stercoralis / Mike M. / June 21, 2025

About two months after receiving a donated kidney, a 61-year-old man ended up back in the hospital. He was tired, nauseous, and vomiting. He was also excessively thirsty and producing too much urine. Over the next 10 days, things only got worse. The oxygen levels in his blood began to fall. His lungs filled with fluid. He kept vomiting. He couldn’t eat. Doctors inserted a feeding tube. His oxygen levels and blood pressure kept falling. He was admitted to the intensive care unit and put on mechanical ventilation. Still, things kept getting worse.

At that point, he was transferred to the ICU of Massachusetts General Hospital, where he had received the transplant. He was in acute respiratory failure and shock.

In a case report in this week’s issue of the New England Journal of Medicine, doctors at Mass General explained how they determined what was wrong with the man. Their first steps were collecting more information about the man’s symptoms from his wife, reviewing his family medical history, and contacting the regional organ-procurement organization that provided the kidney.

Process of elimination

The man’s condition and laboratory tests suggested he had some sort of infection. But as a transplant recipient who was on a variety of immunosuppressive drugs, the list of infectious possibilities was “extensive.”

Dr. Camille Kotton, Clinical Director of the hospital’s Transplant and Immunocompromised Host Infectious Diseases division, laid out her thinking. She started with a process of elimination. As an immunosuppressed transplant patient, he was also on several medications to proactively prevent infections. These would rule out herpesviruses and cytomegalovirus. He was also on a combination of antibiotics that would rule out many bacterial infections, as well as the fungal infection Pneumocystis jirovecii that strikes the immunocompromised and the protozoan parasite Toxoplasma gondii.

One feature stood out: The man had developed elevated levels of eosinophils, white blood cells that can increase for various reasons—including parasitic infections. The man also had a reddish-purple rash over his abdomen. Coupled with the severity of his illness, Kotton suspected a widespread parasitic infection.

The man’s history was notable for contact with domestic cats and dogs—including a cat scratch in the time between having the transplant and falling critically ill. But common bacterial infections linked to cat scratches could be ruled out. And other parasitic infections that might come from domestic animals in the US, such as toxocariasis, don’t typically lead to such critical illnesses.

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Burning in woman’s legs turned out to be slug parasites migrating to her brain

It started with a bizarre burning sensation in her feet. Over the next two days, the searing pain crept up her legs. Any light touch made it worse, and over-the-counter pain medicine offered no relief.

On the third day, the 30-year-old, otherwise healthy woman from New England went to an emergency department. Her exam was normal. Her blood tests and kidney function were normal. The only thing that stood out was a high number of eosinophils—white blood cells that become active with certain allergic diseases, parasitic infections, or other medical conditions, such as cancer. The woman was discharged and advised to follow up with her primary care doctor.

Over the next few days, the scorching sensation kept advancing, invading her trunk and arms. She developed a headache that was also unfazed by over-the-counter pain medicine. Seven days into the illness, she went to a second emergency department. There, the findings were much the same: Normal exam, normal blood tests, normal kidney function, and high eosinophil count—this time higher. The reference range for this count was 0 to 400; her count was 1,050. She was given intravenous medicine to treat her severe headache, then once again discharged with a plan to see her primary care provider.

At home again, with little relief, a family member gave her a prescription sleep aid to help her get some rest. The next day, she awoke confused, saying she needed to pack for a vacation and couldn’t be reasoned with to return to bed. After hours in this fog, her partner brought her to an emergency department for a third time, this time the one at Massachusetts General Hospital.

Getting warmer

In a case report published in the New England Journal of Medicine, doctors explain how they figured out the source of her fiery symptoms—worms burrowing into her brain. By this point, she was alert but disoriented and restless. She couldn’t answer questions consistently or follow commands.

The doctors at Mass General, including a neurologist specializing in infectious diseases, quickly focused their attention on the fact that the woman had recently traveled. Just four days before her feet began burning, she had returned from a three-week trip that included stops in Bangkok, Thailand; Tokyo, Japan; and Hawaii. They asked what she ate. In Thailand, she ate street foods but nothing raw. In Japan, she ate sushi several times and spent most of her time in a hotel. In Hawaii, she again ate sushi as well as salads.