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December 2015

Extended Perineal Dermatobia hominis Myiasis in a Traveler Returning From South America

Author Affiliations
  • 1Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille, France
  • 2Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, Aix Marseille Université, Marseille, France
JAMA Dermatol. 2015;151(12):1389-1390. doi:10.1001/jamadermatol.2015.2608

As an increasing number of travelers visit tropical regions, western physicians will find themselves treating more patients with travel-associated infection.1 Among them, skin diseases account for nearly 10% of medical situations, and myiasis represents 7% to 11% of imported dermatosis.1

A man in his 60s presented with pruriginous perineal nodules on his return from travel in South America. There was no history of insect or mosquito bites, and the patient denied total nudity or defecation in the outdoor environment. Within 2 days of his return, he presented with painful, erythematous, scrotal furuncle-like nodules, and he described a sensation of movement within the nodules. Ten furunculoid lesions with a central punctum exuding serosanguineous fluid were identified on the scrotum, the gluteal furrow, the inguinal fold, and the perianal region (Figure, A). No cellulitis or lymphadenopathy were highlighted, and the patient remained afebrile. Biological examination showed a normal blood cell count without hypereosinophilia, and moderate inflammation. Furuncular myiasis was diagnosed after occlusion of the lesions by petroleum jelly, encouraging movement of the maggots. Each nodule excision extracted 1 larva (Figure, B). Parasitologic examination identified Dermatobia hominis larvae, even though they usually affect exposed areas. Follow-up at 3 weeks demonstrated complete recovery.