Nasal Myiasis Associated With E. coli Bacteremia, Spinal Osteomyelitis, and Epidural Abscess: A Case Report

Nasal myiasis is a rare parasitic infestation that can predispose to secondary bacterial infection, though progression to systemic complications is uncommon. Cases in nonendemic regions are rare and may present diagnostic challenges.

We report a case of community-acquired nasal myiasis in a 65-year-old woman presenting with an altered level of consciousness, found to have E. coli bacteremia and subsequent spinal osteomyelitis complicated by an epidural phlegmon requiring surgical decompression. Larvae were directly visualized within the anterior nasal cavity, with no evidence of deeper airway involvement or additional sites of infestation. Despite extensive investigation, including abdominal and pelvic imaging, no alternative infectious source was identified. Intraoperative cultures were negative following approximately 16 days of antimicrobial therapy.

Although a direct microbiological link between the nasal infestation and bacteremia could not be established, the clinical findings support a plausible secondary bacterial invasion facilitated by mucosal disruption.

This case highlights the potential for severe systemic complications arising from nasal myiasis and underscores the importance of early recognition and thorough evaluation of atypical sources of bacteremia.