Unusual Presentation of Nasal Myiasis in Immunocompetent Young Individual: Case Report

Nasal myiasis, an infestation by fly larvae, is a rare condition typically associated with immunocompromised individuals, poor hygiene, and low socioeconomic status. It is commonly seen in tropical regions and is often linked to chronic sinonasal diseases or underlying health conditions. However, cases in healthy individuals without predisposing factors are uncommon, making this case novel and worthy of documentation. The importance of timely diagnosis and effective management in preventing severe complications cannot be overstated.

A 40-year-old male presented to the emergency department with complaints of left nasal bleeding for three days, which was profuse, intermittent, and spontaneously resolved. The patient also reported left nasal obstruction, crawling sensation in the nose, facial pain, headache, and toothache, with no history of fever, cough, post-nasal drip, or ear-related issues. Examination revealed a normal right nasal cavity, while the left nasal cavity was blood-stained with clots present. The oral cavity appeared normal. No underlying co-morbidities for the patient. Diagnostic nasal endoscopy on presentation showed a blood-stained left nasal cavity with clots extending to the choana, slough over the inferior turbinate, and maxillary ostium. Subsequent endoscopy revealed extensive maggots in the inferior meatal region, extending into the maxillary, ethmoidal, and sphenoid sinuses, causing mucosal erosion and exposed bones. Patient underwent serological test were negative followed by Computed tomography of the nose and paranasal sinuses revealed mucosal thickening with heterogeneous secretions in the left frontal, ethmoidal, maxillary, and sphenoid sinuses and erosion of the left inferior and middle turbinates. The patient was managed with continuous manual extraction of maggots through endoscopy using turpentine oil, followed by saline nasal irrigation. Empirical intravenous antibiotics were administered, and the patient underwent surgical debridement to remove unhealthy nasal mucosa and slough from the maxillary ostium, ethmoid, and sphenoid sinuses. No maggots were observed during the procedure, and the patient's condition improved significantly post-treatment.

This case of nasal myiasis in an immunocompetent individual without predisposing factors highlights the need for increased vigilance and awareness in diagnosing and managing this rare condition. Proper hygiene and prompt medical intervention are crucial in preventing severe complications. Public health education and improved sanitation practices are vital in combating this preventable yet distressing condition.