Nasal Myiasis in Pediatric Age Group: Case Report
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A 6 year-old previously healthy girl presented for generalized fatigue and fever 1 week prior to presentation, refractory to antibiotics. She was found to have laboratory tests in keeping with tumor lysis syndrome and was later diagnosed with hemophagocytic lymphohistiocytosis caused by Epstein-Barr virus. The patient was intubated, had multiorgan system failure, was compromised and was being treated supportively and with IV antibiotics. One week after admission to the hospital, the patient was found to have a maggot coming out upon suctioning the oral cavity.

Flexible fiber optic laryngoscopy was performed through the oral cavity and was negative. It was then performed through the nose and she was found to have 2 maggots in the right nasal cavity, at the level of the right middle turbinate. The left nasal cavity was clear.

CT scan of sinuses was done and showed a heterogeneous collection in the right posterior nasal cavity with air loculus and secretions as well as mucosal thickening in the paranasal sinuses. Decision was made to take the patient to the operating room for endoscopic removal of the larvae and inspection of the cavities looking for the nest. Intraoperatively, the left nasal cavity was found to be clear. Two maggots were found in the right nasal cavity and a maxillary antrostomy was performed. The right maxillary sinus was clear of maggots. The nasopharynx, oral cavity and bilateral ears were also carefully examined in the operating room and were found to be free of disease.

Finally, a flexible endoscopy was performed through the endotracheal tube and bilateral bronchi were explored with no findings significant for myiasis. Saline washes administered postoperatively. The larva was sent to pathology and parasitology and was found to be Oestrus ovis. The patient was prescribed nasal saline washes and she was seen again at postoperative day ten with no evidence of recurrence.

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