A female adolescent aged 17 years presented to our department on day 3 of antibiotic therapy with worsening inflammatory signs and impaired gait, without fever. Three days earlier, she had undergone initial evaluation for right foot pain and swelling and was prescribed amoxicillin-clavulanic acid, which achieved an improvement at first. She had returned from Senegal three days earlier and reported an insect bite on her foot one week prior, despite using a repellent. The physical examination revealed an erythematous elevated lesion with a central white punctum, warmth and swelling (Fig. 1 A). Cutaneous myiasis was suspected, and an occlusive dressing was considered. Direct visualization of the larva enabled mechanical removal, confirming the diagnosis (Video 1, Fig. 1B). Treatment with flucloxacillin and topical tetracycline for suspected secondary bacterial infection achieved full clinical resolution after a 10-day course.

Figure 1.

Cutaneous furuncular myiasis of the foot. (A) Furuncular lesion on the lateral aspect of the right foot, characterized by an elevated erythematous nodule with a central white punctum (larval breathing pore); (B) Residual cavity after mechanical extraction of the larva.

Globalization calls for increased awareness of tropical travel-related diseases such as myiasis.1 Furuncular myiasis, often seen in returning travelers, is typically caused by fly larvae that penetrate the skin and develop in subdermal tissue.2 It usually presents as a slowly enlarging lesion resembling an infected insect bite.1 Complete removal of the larva, along with prevention and control of secondary infection, are the main goals of treatment.3