Cutaneous Myiasis

A 5-year-old boy is referred from an Army hospital in Panama in the mid-1980s to Brooke Army Medical Center for evaluation of an unrelated problem when his parent asked about a case of several “impetiginous lesions” that will not heal.

A healthy 10-year-old male presents with seven discrete, very pruritic sores on his back. They seem to have originated as typical mosquito bites while he vacationed in Costa Rica for 7 days. The family returned home 12 days prior to presenting to their primary care physician, and since then, the lesions have been slowly but pro-gressively getting larger. The patient and his father also had complained of some transient nausea and vomiting symptoms that have since resolved. Otherwise, the patient has had no other complaints and no fever noted. Some lesions were noted to have had some intermittent drainage. The first time the patient was evaluated, he was diagnosed with impetigo and cellulitis and treated with cephalexin. This did not appear to work, as the le-sions continued to get somewhat larger (Figure 1), with more intermittent oozing of material. The patient was then prescribed clindamycin, which he would not take after the first few doses. As expected, this also did not seem to have any benefit. Shortly thereafter, the mother noted the appearance of dark, black material oozing from one of the lesions with some bubbles (Figure 2).