# A scalp to make you squirm: Cutaneous myiasis hiding a unique presentation of disseminated coccidioidomycosis

## TL;DR

A young girl developed a rare skin infection from coccidioidomycosis, leading to complications like wound myiasis and requiring major surgery and long-term treatment.

## Contribution

This case highlights a unique and delayed presentation of disseminated coccidioidomycosis with cutaneous and myiasis complications in a previously healthy child.

## Key findings

- The patient had a delayed diagnosis of cutaneous scalp coccidioidomycosis with disseminated disease.
- Secondary wound myiasis and bacterial superinfection occurred, requiring surgical debridement and skin grafting.
- Prolonged antifungal therapy was needed, with a unique adverse effect experienced.

## Abstract

Coccidioidomycosis is predominantly a pulmonary disease, however dissemination can include unique cutaneous presentations. We report a previously healthy 11-year-old female with delayed diagnosis of cutaneous scalp coccidioidomycosis with disseminated disease with secondary wound myiasis and bacterial superinfection. She required extensive surgical debridement, eventually requiring a skin graft and prolonged hospitalization for antifungal therapy, experiencing a unique adverse effect.