PROLONGED ANGIOEDEMA FOLLOWING BOT FLY INFESTATION

Abstract

Introduction Dermatobia hominus, (human botfly), is endemic throughout Central and South America. Infestation occurs when larvae burrow into human skin to mature. Left untreated, mature botfly burrow out of the host. During the larval stage symptoms include locally painful, firm pustules often with a centrally located pore. We report a unique case of myiasis in a patient who presented with urticaria and angioedema. Angioedema in the context of myiasis is not well described in literature. Angioedema Case Description A 64-year old female, presented with pruritic scalp lesions to her primary care physician and was referred to a dermatologist. A week later, she was seen by the dermatologist and presented to an emergency department on two occasions with angioedema. At the first visit, the patient presented with urticaria and swollen lips. Within the week, she presented with more involved angioedema. On both occasions, she improved rapidly following epinephrine and steroids and was discharged. Following the second ED visit, she was referred to allergy clinic. A week later, the allergy clinic social history revealed that the patient traveled to Belize two weeks prior to her initial presentation. Subsequently, dermatology removed a bot fly and plastic surgery removed remaining larvae from her scalp. Symptoms resolved within weeks of larvae extraction. Discussion Our patient likely presented with an IgE mediated hypersensitivity reaction to botfly larvae. Limited awareness of botfly infestation outside endemic areas often leads to misdiagnosis and mismanagement. This case emphasizes the importance of a thorough social history and physical exam.