Point-of-care ultrasound diagnosis and procedural guidance for pediatric bot fly infestation: A case report
- 1Nicklaus Children's Hospital, Department of Pediatric Emergency Medicine, Miami, FL, USA; Florida International University, Herbert Wertheim College of Medicine, USA
- 2Nicklaus Children's Hospital, Department of Pediatric Emergency Medicine, Miami, FL, USA; Florida International University, Herbert Wertheim College of Medicine, USA; Corresponding author. Nicklaus Children's Hospital, Department of Pediatric Emergency Medicine, 3100 SW 62nd Ave, Miami, FL, 33155, USA.
- 3Nicklaus Children's Hospital, Department of Pediatric Emergency Medicine, Miami, FL, USA
Abstract
Background: Furuncular myiasis caused by Dermatobia hominis is an uncommon diagnosis in non-endemic regions and is frequently mistaken for cellulitis or abscess, resulting in delayed diagnosis and unnecessary antibiotic therapy. Although point-of-care ultrasound (POCUS) is widely used to evaluate soft tissue infections, its role in diagnosing and managing pediatric bot fly infestation remains poorly described. Case report: A previously healthy 2-year-old male presented to the emergency department with 2–3 weeks of progressive scalp swelling after recent travel to Brazil. He had been treated with cephalexin for presumed cellulitis without improvement. Physical examination revealed localized scalp swelling with pinpoint skin openings. POCUS demonstrated multiple (>5) oblong hyperechoic structures approximately 0.5 cm beneath the skin with posterior acoustic shadowing and real-time movement, without evidence of abscess, consistent with bot fly larvae. Ultrasound was used to localize the larvae and guide incision and extraction. Five larvae were removed in the emergency department, and the patient was referred to pediatric surgery for complete removal under procedural sedation because of the extensive infestation. Why should an emergency physician be aware of this?: Emergency physicians should consider furuncular myiasis in patients with persistent soft tissue swelling after travel to endemic regions, particularly when symptoms fail to improve with antibiotics. POCUS enables rapid diagnosis, differentiates myiasis from cellulitis or abscess, guides targeted larval extraction, and may prevent unnecessary antibiotic therapy.
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BibTeX
@article{creech2026pointofcare,
title = {{Point-of-care ultrasound diagnosis and procedural guidance for pediatric bot fly infestation: A case report}},
author = {Jonathan Creech and Tomas Leng and Barbara Ximenes Braz and Cloty Toro and Paul Khalil and Mark Hincapie},
journal = {JEM Reports},
year = {2026},
month = oct,
doi = {10.1016/j.jemrpt.2026.100282},
url = {https://doi.org/10.1016/j.jemrpt.2026.100282},
note = {CC BY},
}
RIS
TY - JOUR
TI - Point-of-care ultrasound diagnosis and procedural guidance for pediatric bot fly infestation: A case report
AU - Jonathan Creech
AU - Tomas Leng
AU - Barbara Ximenes Braz
AU - Cloty Toro
AU - Paul Khalil
AU - Mark Hincapie
PY - 2026
DA - 2026/10/30
JO - JEM Reports
DO - 10.1016/j.jemrpt.2026.100282
UR - https://doi.org/10.1016/j.jemrpt.2026.100282
AB - Background: Furuncular myiasis caused by Dermatobia hominis is an uncommon diagnosis in non-endemic regions and is frequently mistaken for cellulitis or abscess, resulting in delayed diagnosis and unnecessary antibiotic therapy. Although point-of-care ultrasound (POCUS) is widely used to evaluate soft tissue infections, its role in diagnosing and managing pediatric bot fly infestation remains poorly described. Case report: A previously healthy 2-year-old male presented to the emergency department with 2–3 weeks of progressive scalp swelling after recent travel to Brazil. He had been treated with cephalexin for presumed cellulitis without improvement. Physical examination revealed localized scalp swelling with pinpoint skin openings. POCUS demonstrated multiple (>5) oblong hyperechoic structures approximately 0.5 cm beneath the skin with posterior acoustic shadowing and real-time movement, without evidence of abscess, consistent with bot fly larvae. Ultrasound was used to localize the larvae and guide incision and extraction. Five larvae were removed in the emergency department, and the patient was referred to pediatric surgery for complete removal under procedural sedation because of the extensive infestation. Why should an emergency physician be aware of this?: Emergency physicians should consider furuncular myiasis in patients with persistent soft tissue swelling after travel to endemic regions, particularly when symptoms fail to improve with antibiotics. POCUS enables rapid diagnosis, differentiates myiasis from cellulitis or abscess, guides targeted larval extraction, and may prevent unnecessary antibiotic therapy.
SN - 2773-2320
ER -