Rench Thomas, Orefice Paul, Simon Erin L
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio.
Department of Emergency Medicine, Cleveland Clinic Akron General, Akron, Ohio; Northeast Ohio Medical University, Rootstown, Ohio.
J Emerg Med. 2025 Oct;77:30-33. doi: 10.1016/j.jemermed.2025.07.005. Epub 2025 Jul 3.
Furuncular myiasis is a rare parasitic infestation caused by fly larvae in the skin, typically presenting as painful, inflammatory nodules. In the United States, the most common causative agent is Dermatobia hominis (human botfly), though autochthonous cases are exceedingly rare. These are caused by the rodent botfly Cuterebra, which is endemic to North America. Humans are incidental hosts, often through outdoor activities near rodent burrows. Diagnosis can be challenging, as it may resemble more common conditions such as an abscess or cellulitis.
A 28-year-old female presented to the emergency department with swelling, erythema, and intermittent pain in the left cheek, following a suspected insect bite during a camping trip in Northeast Ohio. Despite treatment for a suspected abscess, the lesion worsened, and the patient reported movement under the skin. Ultrasound confirmed a 2cm larva with spicules, consistent with furuncular myiasis. The larva was successfully removed via a small incision under local anesthesia. Postprocedure, the wound was cleaned, sutured, and dressed, and the patient was discharged with antibiotics and follow-up instructions. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Furuncular myiasis, though rare in the U.S., should be considered when a patient presents with a slow-growing nodule following outdoor activities. Diagnosis can be made quickly using point-of-care ultrasound (POCUS), which can differentiate myiasis from common soft tissue infections like abscesses. Early identification enables appropriate management and prevents unnecessary interventions, such as prolonged antibiotic therapy. Emergency physicians should be aware of this rare but significant condition, especially in patients with a history of outdoor exposure or travel to Central or South America.
疖肿蝇蛆病是一种罕见的皮肤寄生虫感染，由蝇幼虫引起，通常表现为疼痛性炎性结节。在美国，最常见的病原体是人皮蝇（Dermatobia hominis），不过本土病例极为罕见。这些病例是由北美特有的鼠蝇蛆（Cuterebra）引起的。人类是偶然宿主，通常是通过在啮齿动物洞穴附近进行户外活动而感染。诊断可能具有挑战性，因为它可能类似于脓肿或蜂窝织炎等更常见的病症。
一名28岁女性因在俄亥俄州东北部露营旅行时疑似被昆虫叮咬，左侧脸颊出现肿胀、红斑和间歇性疼痛，前往急诊科就诊。尽管对疑似脓肿进行了治疗，但病变仍恶化，患者报告皮下有活动感。超声检查证实有一条2厘米长带刺的幼虫，符合疖肿蝇蛆病。在局部麻醉下通过一个小切口成功取出幼虫。术后，伤口进行了清洗、缝合和包扎，患者出院时带了抗生素及后续随访指示。急诊科医生为何应了解此情况？：疖肿蝇蛆病在美国虽罕见，但当患者在户外活动后出现生长缓慢的结节时应予以考虑。使用即时超声（POCUS）可快速做出诊断，它能将蝇蛆病与脓肿等常见软组织感染区分开来。早期识别有助于进行适当的管理并防止不必要的干预，如长期抗生素治疗。急诊科医生应了解这种罕见但重要的病症，尤其是对于有户外暴露史或前往中美洲或南美洲旅行史的患者。
