Case Study - Deep Cutaneous Mass Excision Reveals an Unusual Finding

Abstract

Case presentation of a 62-year-old male who presented to the emergency department complaining of a mass in his right hand which began 14 days prior to evaluation. The mass was located in the proximity of the multiple neurovascular structures; therefore, surgical excision in the operating room was required. The patient’s pathological findings revealed a thick-walled, smooth surfaced cyst consistent with a bot fly larva (Dermatobia hominis) enclosed in an exoskeleton casing, rendering the diagnosis furuncular myiasis. Because areas of cutaneous myiasis are frequently misdiagnosed as pyogenic infection, it is important that the clinician maintains bot fly larvae in their differential diagnosis for a boil-type lesion in a patient that has visited the American tropics. It is imperative that providers consider surgical consultation in cases of suspected cutaneous myiasis due to the likelihood of complex anatomical structural involvement or unforeseen difficulty in removal when the larva is located subdermally with fascial encasement.