A rare nasal myiasis in a patient with diabetes mellitus

Background: Nasal myiasis, a type of cavitary myiasis, is an infestation of parasitic insect larvae or eggs in the nasal cavity of the human body. The risk of nasal myiasis increases in individuals with immunocompromised such as diabetes mellitus (DM). The aim of this study was to report a rare case of nasal myiasis in a patient with DM. Case Presentation: A 54-year-old female patient was referred to Dr. Soetomo General Hospital Surabaya with a chief complaint of spontaneous anterior epistaxis from the left nostril for three days. Anterior rhinoscopy revealed a narrowed left nasal cavity covered with excessive bloody discharge and>50 larvae coming out of the nasal passage. Nasoendoscopy showed ulcerated lesions on the left nasal cavity floor and nasal lateral wall, destructions of the osteomeatal complex and lateral wall, thick bloody discharge with excessive crust, as well as a larva around the osteomeatal complex entering the maxillary sinus. Paranasal sinus CT scan showed no further infection to surrounding organs. The patient had a history of type 2 DM for the past 2.5 years. The patient was diagnosed with nasal myiasis, unregulated type 2 DM, and diabetic neuropathy. Therapies included larval removal by endoscopy, wound irrigation using antiseptic solutions, maxillary sinus irrigation, administration of the topical antiparasitic ivermectin, and insulin therapy. After seven days of the treatment, the patient was discharged from the hospital with a resolved infection and controlled blood sugar levels. Conclusion: Awareness of risk factors for myiasis along with proper therapy is prominent. Nasal endoscopy, together with nasal irrigation and antiparasitic drug administration was effective in the management of nasal myiasis.