Discover 4

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By the time he reached

Los Angeles, Landry

was scared, dazed and

exhausted. Flying for the

first time in his life, the

13-year-old from Cameroon

was now some 8,200 miles

from all things familiar.

Landry, whose parents

had recently died in a car

crash, came to LA to live

with his legal guardian.

Although Aunt Delphine

welcomed him warmly,

Landry’s first night in

America was restless. His left

ankle was puffy and warm.

He settled in to his new

environment, attending

school and studying English

while speaking French and

Cameroonian pidgin at home. He

played soccer and watched YouTube

videos on his cellphone. But his ankle

and lower leg continued to swell

on occasion.

“In the hospital where I work,”

Delphine, a certified nursing assistant,

told Landry, “elderly people can have

blood clots that make their limbs swell.

But in someone your age, that doesn’t

make sense. The next time this funny

thing happens, please tell me tout suite,

and I’ll take you to a clinic.”

Sure enough, Landry’s symptoms

returned, and Delphine cajoled a

local doctor into ordering an MRI

of her nephew’s leg. But the swelling

was gone by the time the scan

was performed.

The doctor shrugged. He wasn’t

convinced that Landry’s swelling was

real. Plus, the boy’s remark about

something under his skin sounded

downright bizarre. Was Landry

suffering from depression? Grief?

Culture shock?

CREEPY CRAWLER

A week later, Delphine asked the clinic

to perform a routine blood test to rule

out an elevated white blood cell count,

which might suggest an infection. The

result was so surprising, the lab called

back the next day.

Although Landry’s total white

count was fine, his array of cells was

not. Instead of the usual

distribution, more than 60

percent were eosinophils,

a type of white blood cell

that normally lives in tissue

rather than blood. Although

scientists still don’t fully

understand how eosinophils

help sustain health, in certain

diseases they surge, spill

into blood and release toxic

proteins.

Doctors must consider

many diagnoses for people

with excess eosinophils.

In a small percentage of

patients, cancer, leukemia or

a rare inflammatory disease

may drive bone marrow to

overproduce this type of

cells. A far more common

cause is an allergy to a

pollen, chemical or drug.

But even when suffering

an allergic crisis, people normally

don’t have Landry’s elevated level

of eosinophils.

Another possibility is a parasite, a

broad category of infectious agents

that are commonly transmitted in the

tropics, including in Cameroon. Of

all the parasites that trigger a massive

outflow of eosinophils, migrating

worms — literally worms that travel

through blood, tissues and organs —

top the list.

Could one of these multicellular

creatures and its offspring reside

within Landry? And if so, what

type? Dr. Kadesadayurat, a local

pediatrician treating the teen, reached

out to me for advice.

“What are we missing?” she asked.

“What test should we run next?”

She had already excluded several

tropical worms, including common

Something Within

A 13-year-old West African boy confounds American doctors with

health complaints that don’t add up.

BY CLAIRE PANOSIAN DUNAVAN

JOHNNY LYE/SHUTTERSTOCK

He played soccer

and watched

YouTube videos

on his cellphone.

But his ankle

and lower leg

continued to swell.

Vital

Signs