Furuncular Cutaneous Myiasis in a Nontraveler: A Case Report

Furuncular cutaneous myiasis is an uncommon cause of a furuncle-like subcutaneous lesion and may be mistaken for a bacterial skin infection. We report the case of a previously healthy 30-year-old Saudi woman who presented with a one-week history of a progressively enlarging lesion on the posterior aspect of the left upper thigh. The lesion was initially asymptomatic but subsequently developed localized pruritus, intermittent sharp pain, and surrounding ecchymosis. One day before presentation, a live larva spontaneously emerged through a central punctum after the patient noted discharge from the lesion. She had no recent travel or recognized animal exposure but reported recent exposure to a recreational farm. Examination revealed a solitary subcutaneous lesion with a central punctum and minimal surrounding induration, without extensive erythema, fluctuance, or active discharge. The extracted larva was submitted to the parasitology laboratory for identification. The diagnosis of furuncular cutaneous myiasis was based on the characteristic furuncle-like lesion, central punctum, localized pruritus and pain, and spontaneous extrusion of a live larva. Following larval extrusion, the patient's pain resolved almost completely, with no further significant discharge reported. This case highlights the importance of considering furuncular cutaneous myiasis in the differential diagnosis of an atypical furuncle-like lesion, including in patients without a history of international travel.