# Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy

## TL;DR

A traveler from Ethiopia had a rare severe case of myiasis, a skin infestation by fly larvae, complicated by a bacterial infection after taking albendazole.

## Contribution

This case highlights an unusual extent of myiasis and its complications following larvicidal therapy in a returning traveler.

## Key findings

- The patient had 27 lesions at varying stages, with 3 showing signs of secondary infection.
- Albendazole treatment rendered larvae non-motile, but Streptococcus pyogenes was detected in wound swabs.
- Lesions improved with wound occlusion and systemic antibiotics, though no larvae were retrieved for speciation.

## Abstract

Background and Clinical Significance: Furuncular myiasis is a tropical parasitic skin infestation caused by dipterous fly larvae, most commonly affecting travellers to endemic regions. While returning travellers typically present with one or few lesions, extensive parasitism is rare. Increased global mobility and expanding ecological range of myiasis-causing species underscores the need for clinicians in endemic and non-endemic regions to recognise, diagnose, and manage this condition promptly. Awareness of exposure risks—including soil contact, infested clothing, and poor living conditions—is essential to reducing morbidity and preventing complications like secondary bacterial infection. Case Presentation: A healthy male in his forties returned to the UK after a month-long visit to rural Ethiopia, during which he slept on dirt floors and hung his washing on a line. He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement. The patient self-extracted 12 larvae in Ethiopia and subsequently sought local medical attention, receiving Albendazole, after which emerging larvae were non-motile. On UK presentation, he had 27 lesions at varying stages, 3 with signs of secondary infection. Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes. Management included wound occlusion and systemic antibiotics. No further larvae were retrieved, precluding definitive speciation. All lesions improved over subsequent reviews. Conclusions: This case illustrates an unusually extensive presentation of presumed Cordylobia spp. myiasis in a returning traveller, highlighting potential complications following larvicidal therapy. Clinicians should maintain a high index of suspicion for myiasis in patients with compatible cutaneous lesions and relevant history. Increasing travel and shifting vector distributions make familiarity with tropical dermatoses and provision of effective safety measures essential in clinical practice.