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He was an ornithologist who traveled the world extensively, most recently to rural Madagascar, after which he developed postprandial abdominal pain, bloating, weight loss, and eosinophilia. Extensive evaluation initially focused on travel-associated parasites, but repeatedly negative testing, coupled with pretravel tick exposure and delayed symptoms after mammalian meat ingestion, redirected the diagnostic approach to consideration of alpha-gal syndrome.
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It is important to resist anchoring bias in returning travelers, and compelling exposure histories can obscure nontravel-related diagnoses. This case also underscores how the expanding geographic range of ticks — driven in part by climate change and changing ecosystems — is making tic…