Sonographic Detection of Cutaneous Myiasis

Area of Science:

• Medical Mycology
• Diagnostic Imaging
• Dermatology

Background:

• Cutaneous myiasis, an infestation of the skin by fly larvae, is an uncommon but recognized condition presenting in emergency settings.
• Elephantiasis nostras verrucosa is a chronic, obstructive lymphedema characterized by hyperkeratosis and verrucous changes, which can create environments conducive to parasitic infections.

Purpose of the Study:

• To report a case of cutaneous myiasis in a patient with elephantiasis nostras verrucosa.
• To demonstrate the utility of ultrasound in identifying maggots within skin crevices, particularly when not fully visible externally.

Main Methods:

• Visual inspection of the skin for signs of maggot infestation.
• Application of ultrasound B-mode imaging to delineate subcutaneous structures and identify larval forms.
• Clinical management of the identified cutaneous maggots.

Main Results:

• Maggots were visually identified on the skin surface.
• Ultrasound successfully detected additional maggots embedded within the deep skin crevices associated with elephantiasis nostras verrucosa.
• Complete removal of maggots was achieved, leading to resolution of the infestation.

Conclusions:

• Ultrasound is a valuable, non-invasive tool for diagnosing cutaneous myiasis, especially in complex cases involving deep skin structures.
• Early and accurate diagnosis facilitated by imaging can improve patient outcomes in cases of myiasis co-occurring with conditions like elephantiasis nostras verrucosa.