Scanning for data on infections that can arise in the three places she visited and align with her symptoms, they came up with a list of 10 possible infectious causes: eight parasites and two fungal pathogens. They went through them one by one, crossing things off the list that didn't quite fit with everything they knew of her case. They ended with angiostrongyliasis, caused by the nematode (roundworm) Angiostrongylus cantonensis, also known as rat lungworm. //

This nauseating roundworm is a known plague in Hawaii. In fact, it gained attention in recent years after sparking small outbreaks in the state. In 2017, there were 19 confirmed cases, but case totals in each of the years since have remained below 10. //

There are no clear treatment strategies for angiostrongyliasis, and some can recover fully without treatment after the larvae die off. In this case, the patient and her doctors decided to use a 14-day combination of the immunosuppressive steroid prednisone and the anti-parasitic drug albendazole.

Fortunately, the woman's symptoms cleared with the treatment, and she was discharged from the hospital after six days.