CASE REPORT Radiologic findings in sinonasal myiasis Carlos S. Duque, MD, Cesar A. Mosquera, MD, Roy R. Casiano, MD, and Clara Eugenia Abreu, DDS, Miami, Florida; and Antioquia, Colombia M yiasis is the infestation of humans by fly larvae. It is commonly associated with poor hygienic conditions in underdeveloped countries. This entity more commonly affects the skin, but it can also develop in the orbit, in the ear, and even more rarely, in the nasal and paranasal si- nuses, where symptoms may mimic rhinosinusitis. 1-4 The following represents two cases with nasopharyngeal and paranasal sinus myiasis, seen at the Hospital Universi- tario San Vicente de Paul in Medellín, Colombia. Both patients were referred from rural areas, living in conditions of extreme poverty. These patients generally seek medical attention only when it is absolutely necessary or where routine treatment by local physicians is unsuccessful or unavailable. Both patients had clinical symptoms suggestive of recalcitrant purulent rhinosinusitis (unresponsive to the usual antimicrobial therapy) with impending orbital com- plications. PATIENT 1 Over a 3-day period, a 68-year-old type II diabetic male developed left facial edema, pain, bilateral mucopurulent nasal discharge, and left otalgia. The rhinologic exam showed marked congestion of the inferior turbinates with mucopurulent secretions. He also had edema of the left lower eyelid. Otherwise, his ophthalmologic evaluation was normal. The remaining head and neck examination was also unremarkable. Cranial nerve examination was grossly nor- mal. His diabetes appeared to be under control with only slightly elevated blood glucose levels. A paranasal sinus CT scan showed mucoperiosteal thickening and an air-fluid level in his left maxillary sinus, marked left intranasal and nasopharyngeal edema and congestion, and scattered areas of ill-defined rounded hypolucencies within the edematous soft tissues. There was no evidence of an intraorbital ab- scess. Despite well-controlled diabetes, an invasive fungal rhi- nosinusitis (ie, mucormycosis) was suspected. He was taken to the operating room for endoscopic evaluation and poten- tial debridement under general anesthesia. After deconges- tion, endoscopic evaluation revealed mucopurulent dis- charge and multiple larvae crawling in and out of the left middle meatus and posterior nasal choana. The patient un- derwent endoscopic debridement of inflammatory debris and multiple larvae. Several larvae were captured alive and intact to facilitate identification. The larvae were identified as Cochliomya hominivorax. Complete removal of all the larvae required two separate returns to the operating room over a 1-week period. The patient went on to recover with- out any further sequelae. PATIENT 2 An 89-year-old male patient was referred from a local hospital, after having been treated for a worsening nasal infection, unresponsive to intravenous antibiotic therapy. Initially he had presented with mild discolored nasal dis- charge, which then became thick and foul smelling over From the Department of Otolaryngology, University of Miami School of Medicine (Drs Duque and Casiano); the Department of Otolaryngology, Universidad de Antioquia (Drs Duque and Mosquera); and the School of Dentistry, Universidad de Antioquia (Dr Abreu). Presented as a poster at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, New York, NY, September 19-22, 2004. Reprint requests: Carlos S. Duque, MD, Rhinology Fellow, Department of Otolaryngology, University of Miami, UMHC Suite # 4025 (D-1), 1475 NW 12th Ave., Miami FL 33136. E-mail address: casiduque@hotmail.com. Otolaryngology–Head and Neck Surgery (2006) 135, 638-639 0194-5998/$32.00 © 2006 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2005.04.012