An Immigrant With Intestinal Myiasis in the United States: A Case Report and a Review of the Literature

Myiasis is an infestation of human tissue by fly larvae. Intestinal myiasis occurs when fly eggs or larvae in contaminated food or water survive passage through the gastrointestinal tract and are found in the stool or bowel lumen. It is more prevalent in developing countries and can present with nonspecific gastrointestinal symptoms that mimic common conditions. A 55-year-old Nepalese-American woman, with a long history of intermittent abdominal pain, nausea, and vomiting, underwent CT imaging, which demonstrated a 2 cm colonic narrowing with wall thickening of the proximal transverse colon. Colonoscopy revealed larvae in the terminal ileum and transverse colon, with adjacent inflammation, and biopsy showed eosinophilic infiltration. Microbiology identified eggs that could not be speciated, and a working diagnosis of intestinal myiasis was made. The patient received bowel preparation and washout, with infectious disease follow-up. Diagnosis was established by direct endoscopic visualization and biopsy. Management focused on mechanical washout, supportive care, and counseling regarding food safety and sanitation. Intestinal myiasis should be considered in patients with unexplained chronic gastrointestinal symptoms, especially those with dietary exposure to food from endemic regions. Direct visualization during endoscopy simplifies diagnosis. Recognition of myiasis may prevent unnecessary prolonged workup and guide appropriate, noninvasive treatment.