Cerebral myiasis in a schizophrenic patient

¹Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

^&Corresponding author
Rajasbala Pradeep Dhande, Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India

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A 32-year-old female presented with a complaint of ulcerated lesions on her scalp for 15 days. They were associated with local swelling and sero-sanguineous discharge. The patient was a known case of schizophrenia, presented in a disoriented state. Examination of the head revealed multiple focal scalp defects (A, B) of each about 2 to 5 cm. The defects showed multiple live maggots in different stages of their lifecycle. Non contrast CT head was advised, which revealed extra-calvarial soft tissue swelling in bilateral parietal region with multiple focal areas of scalp discontinuity. Underlying skull bone was normal. Cerebral myiasis is a rare condition caused by infestation of a live host by larvae of diptera, which feed on the host’s tissues. This condition is primarily diagnosed on history of travel to endemic area and clinical examination. Myiasis has predilection to occur on exposed areas of body. Treatment includes complete manual removal with debridement. Major complications include abscess, osteomyelitis and intracerebral extension. If untreated mortality rate is very high.

Figure 1: (A, B) scalp showing multiple cutaneous and subcutaneous ulcers containing multiple eggs with live larvae (arrow); it is associated with sero-sanguinous discharge