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Dermatobia hominis myiasis (human botfly infection).Young Male With Neck Pain

Young Male With Neck Pain: A 21 year-old man presented to the emergency department with intermittent posterior neck pain. He had recently visited the Peruvian rainforest and recalled being bitten by a mosquito approximately 3 weeks before. He reported recent mild seropurulent drainage from the area, with no fever or constitutional symptoms. Physical examination of the neck revealed a 1-cm raised circular indurated area with a small central punctum. The lesion was warm and tender, and no fluid could be expressed. Ultrasonography revealed a 9×5-mm fluid-filled sac approximately 3 mm under the skin surface.

A 21 year-old man presented to the emergency department with intermittent posterior neck pain. He had recently visited the Peruvian rainforest and recalled being bitten by a mosquito approximately 3 weeks before. He reported recent mild seropurulent drainage from the area, with no fever or constitutional symptoms. Physical examination of the neck revealed a 1-cm raised circular indurated area with a small central punctum. The lesion was warm and tender, and no fluid could be expressed. Ultrasonography revealed a 9×5-mm fluid-filled sac approximately 3 mm under the skin surface. Within the sac there was a 7×3-mm amorphous mass (Figure 1) with spontaneous movements (Video E1, available online at http://www.annemergmed.com). The lesion was opened with a horizontal incision (Figure 2), and a live larval specimen was removed (Figure 3).
Thumbnail image of Figure 1. Opens large image

Figure 1

Ultrasonography demonstrating a 3-mm-diameter isoechoic mass within a surrounding simple fluid collection (arrow).
Thumbnail image of Figure 2. Opens large image

Figure 2

Site of lesion after mosquito bite, on right posterior neck.
Thumbnail image of Figure 3. Opens large image

Figure 3

D hominis larva postextraction.

Diagnosis

Dermatobia hominis myiasis (human botfly infection).The larval stage of the human botfly life cycle occurs within mammalian or avian soft tissue. The vector for botfly egg implantation is usually a blood-sucking arthropod (eg, mosquito). Eggs mature in a subdermal cavity, breathing by extending tongue-like appendages to a hole in the host’s skin. After 5 to 10 weeks, the larva emerges and returns to the ground to mate and mature.1 Extraction improves discomfort caused by the feeding larva, whereas other common treatments include oral ivermectin or directly applying occlusive substances such as petroleum jelly.2 Although myiasis is generally self-limited, with little threat to the patient,3 rare but serious cerebral4 and ocular5 sequelae have been reported.

Supplementary Data

Video E1
Spontaneous movements of an isoechoic mass within a subdermal fluid-filled sac.

References

  1. Centers for Disease Control and Prevention. DPDx—Laboratory identification of parasitic diseases of public health concern: myiasis. Available at:http://www.cdc.gov/dpdx/myiasis/index.html. Updated June 24, 2015. Accessed May 2, 2016.
  2. Jelinek, T., Nothdurft, H.D., Rieder, N. et al. Cutaneous myiasis: review of 13 cases in travelers returning from tropical countries. Int J Dermatol199534624–626
  3. Tamir, J., Haik, J., Orenstein, A. et al. Dermatobia hominis myiasis among travelers returning from South America. J Am Acad Dermatol200348630–632
  4. Holanda, L.F., Pereira, B.J., de Holanda, C.V. et al. Cerebral myiasis. Neurology201584434–435
  5. Alsaif, N., Liao, S., and Tse, D.T. External ophthalmomyiasis due to Dermatobia hominismasquerading as orbital cellulitis. Ophthal Plast Reconstr Surg201432e113–e116
For the diagnosis and teaching points, see page e90.
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